COMPARING PUBLIC POLICIES IN MULTILEVEL

GOVERNANCE SYSTEMS:

TOBACCO CONTROL IN THE EUROPEAN UNION

A Dissertation

by

HOLLY THOMPSON GOERDEL

Submitted to the Office of Graduate Studies of Texas A&M University

in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

May 2007

Major Subject: Political Science

COMPARING PUBLIC POLICIES IN MULTILEVEL

GOVERNANCE SYSTEMS:

TOBACCO CONTROL IN THE EUROPEAN UNION

A Dissertation

by

HOLLY THOMPSON GOERDEL

Submitted to the Office of Graduate Studies of Texas A&M University

in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

Approved by:

Chair of Committee, Kenneth J. Meier Committee Members, Kim Q. Hill Guy D. Whitten Hank C. Jenkins-Smith Head of Department, Patricia Hurley

May 2007

Major Subject: Political Science

iii

ABSTRACT

Comparing Public Policies in Multilevel Governance Systems:

Tobacco Control in the European Union. (May 2007)

Holly Thompson Goerdel, B.S., Texas A&M University

Chair of Advisory Committee: Dr. Kenneth J. Meier

This is a comprehensive study of tobacco control policy and politics in the

European Union, 1970-2000. I develop an instrumental theory of public policy which

establishes an approach for connecting policy instruments to policy outcomes. I

investigate ways in which political, bureaucratic and interest group (particularly the

tobacco industry) factors influence the success of policy instruments aimed at reducing

cigarette consumption. I also explore whether and how supranational mandates and

directives influence the success of national-level efforts to control tobacco. I test

hypotheses empirically using pooled time-series methodologies.

The substantive conclusion is that non-price policies are only a qualified success

when controlling for addiction, price policy and factors in the policy environment. Price

policy is consistently effective, cross-nationally and the public health bureaucracy is a

key player in curbing consumption of cigarettes. Major theoretical conclusions include

affirmation that supranational policy actions can shape national policy outcomes, that

interest group pluralism favors those with a comparative advantage in organizing (in this

iv

case, the tobacco industry), and that while policy instruments can be evaluated according

to their behavioral attributes, caution should be exercised when simultaneous policy

adoption is occurring.

v

ACKNOWLEDGEMENTS

I credit the completion of this project to the guidance and support from a number

of very special people including my advisor, committee, spouse, friends, and numerous

colleagues. Ken Meier stands out as exceptional for many reasons. As my advisor he

inspired fear and aptitude. Few mentors can traverse that space well; Ken is one of them.

Most importantly, Ken has imparted a passion for intellectual rigor and provocation.

I also owe a debt of gratitude to Kim Hill, Guy Whitten and Hank Jenkins-Smith

for their help in getting this project completed. They are gifted critics; they craft

feedback in a way that expands on even the smallest of innovative ideas. And, they

challenge me with their expectations because they want me to succeed. Up close and at

a distance I have watched their scholarly routines and they have fundamentally changed

how I approach my work. I am grateful for their influence on my professional

development.

I also extend my gratitude to Patricia Hurley, department head at Texas A&M

University and to other professors at Texas A&M who invested time in me, including

Jan Leighley (now in Arizona), Carol Silva, George Edwards, Dan Wood, Tony Bertelli

(now in Georgia), Dave Peterson, Jon Bond, Maria Escobar-Lemon, and Michelle

Taylor-Robinson. Carrie Kilpatrick and Lou Ellen Herr helped me navigate university

bureaucracy many times.

My personal acknowledgements begin with the love of my life, Thomas. It takes

a special partner to support someone completing a dissertation. Thomas supplied

strength, patience, laughter, and wine – always at the perfect time and proportion. I am

vi

exceptionally blessed to have him in my life. I am also grateful to Brandy Durham and

Dunia Andary for their love and encouragement for seeing this through. I am energized

by them and I am constantly inspired by their vibrant personalities and intellect. There

were many times this project benefited from taking breaks where these two had me

laughing to tears. I would be lost without them.

Finally, I extend my warmest appreciation to my family for their perseverance

and support throughout the process. My father, Lewis, and my mother, Nancy, have

supported my scholarly goals since the first grade, when I came home upset over not

acing my first math test. My sister, Emily, generated positive energy any time I called or

visited her during this process. Finally, Amy has been an exceptional source of comfort

and encouragement for every-and-any ambitious goal I have set over my lifetime.

vii

NOMENCLATURE

CAC Command and Control policy instruments

ENSP Euroepan Network for Smoking Prevention

EU European Union

FCTC Framework Convention on Tobacco Control

ISO International Organization for Standardization

SEM Single European Market

SPM Supranational Policy Mandate

TEC Treaty Establishing the European Community

TEU Treaty on European Union

viii

TABLE OF CONTENTS

Page

ABSTRACT…………………………………………………………………… iii

ACKNOWLEDGEMENTS…………………………………………………… v

NOMENCLATURE…………………………………………………………… vii

TABLE OF CONTENTS……………………………………………………… viii

LIST OF FIGURES……………………………………………………………. xi

LIST OF TABLES…………………………………………………………….. xii

CHAPTER

I INTRODUCTION………………………………………………........... 1

Tobacco Control in the European Union……………………….. 1 Purpose of Project………………………………………. 2 Policy Problem…………………………………….......... 5 Cigarette Consumption in Europe 1970-2000……………. 8 Research Orientation for Tobacco Control……………………… 12 Substantive (Policy) Case Study…………………… …... 12 Quantitative Historical Analysis………………………… 15 Quantitative Cross-Sectional Analysis………………….. 16 II RESEARCH ORIENTATION FOR TOBACCO CONTROL…………. 17 Tobacco Control in the Literature……………………………… 17 Agenda-Setting and Tobacco Control …………………. 18 Social Movements, Interest Group Conflict, and Tobacco Control…………………………….. 19 Partisanship, Ideology, and Tobacco Control…………… 21 Political Institutions and Tobacco Control ……………… 22 Policy Typologies, Diffusion, Instruments and Tobacco Control…………………………… 25 Policy Instruments and Tobacco Control………………. 33 Developing an Instrumental Theory of Policy Effectiveness........ 37

ix

CHAPTER Page III TOBACCO CONTROL EFFORTS ACROSS MEMBER STATES……………………………………………………………..….. 40

Member State Policy Instruments……………………….. 40 Austria: Tobacco Control………………………… 41 Belgium: Tobacco Control ……………………….. 44 Denmark: Tobacco Control ……………………… 48 Finland: Tobacco Control …………………….…. 51 France: Tobacco Control …………………….….. 53 Germany: Tobacco Control ………………….…... 57 Greece: Tobacco Control ………………………… 58 Italy: Tobacco Control …………………………… 60 Netherlands: Tobacco Control …………………… 62 Portugal: Tobacco Control ………………………. 64 Spain: Tobacco Control ………………………….. 65 Sweden: Tobacco Control ....…………………….. 69 United Kingdom: Tobacco Control ……………… 71 Framework for European Tobacco Control Policy Explanations………..……………………………. 73 IV TOBACCO CONTROL AND HEALTH GOVERNANCE……..…………………………………………………... 82

Tobacco Policy Interventions as Mechanisms of Governance …... 83 Governance……………………………………………….. 84 Governance Mechanisms, Multilevel Systems and Policy Outcomes………………………………………….. 85 Tobacco Control and Policy Instrument Effectiveness……………. 88 Developing a Model for Tobacco Policy Effectiveness…………… 88 Cigarette Price Policy……………………………………… 90 Non-Price Tobacco Policies……………………………….. 94 Information Policy…………………………………………. 97 Command-Control Policy………………………………….. 99 Multiple Interventions…………………………………….. 101 Habit-Persistence: Robust Contextual Factor…………….. 103 Bureaucratic Influences……………………………………104 Industry Influences………………………………………...105 Political Factors……………………………………………108 Measuring Concepts and Data……………………………..109

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CHAPTER Page Methods and Data Structure……………………………. 114 Hypotheses……………………………………………... 116 Findings………………………………………………… 118 Further Analysis…………………………………………..……. 123 Conclusion……………………………………………………… 128 V TOBACCO CONTROL AND SUPRANATIONAL GOVERNANCE……….……………………………………….............. 131

Tobacco Control Directives and European Union …………….... 131 Mandate for European Health Governance: Treaty on European Union……………………………………… 143 Empirical Investigation of a Public health Mandate..................... 146 Hypotheses and Expectations…………………………………… 148 Evidence…………………………………………………………. 149 Discussion and Summary………………………………………... 152 VI CONCLUSION…………………………………………………….......... 154 A General Model of Comparative Public Policy............................ 154 Instrumental Theory of Policy Effectiveness: Evidence…………. 156 Implications for Future Tobacco Control in European Union……. 157 REFERENCES…………………………………………………………………… 163 VITA……………………………………………………………………………… 177

xi

LIST OF FIGURES

FIGURE Page

1 Average European Cigarette Consumption, Number of Cigarettes Per Capita, Annually:1970-1980................................... 9

2 Average European Cigarette Consumption, Number of Cigarettes Per Capita: 1980-1990……………………………...… 10

3 Average European Cigarette Consumption, Number of Cigarettes Per Capita: 1990-2000….…………………………..… 11 4 Mean Cigarette Price per Pack (US Cents): 1970-1980…………. 90 5 Mean Cigarette Price per Pack (US Cents): 1980-1990…………. 91 6 Mean Cigarette Price per Pack (US Cents): 1990-2000…………. 92 7 Variation of Non-Price Policies in Europe: 1970-2000........…… 141

8 Variation in Price Policy in Europe: 1970 – 2000……….……… 142 9 New European Union Labels for Tobacco Products...................... 158

xii

LIST OF TABLES

TABLE Page 1 Summary of European Policy Instruments to Control Tobacco, 1970- 2000 ………………………………………….. 75 2 Principal Component Factor Analysis of Tobacco Control Policy in European Union Countries: 1970-2000……… 77 3 Unrotated Factor Analysis of Tobacco Control Policy in European Union Countries: 1970-2000……………………… 79 4 Principal Component Factor Analysis with Oblique Rotation: Tobacco Control Policy in European Union Countries: 1970-2000………………………………………………………… 80 5 Interest Group Pluralism Scores, EU Member States ……………..114 6 Mapping Hypotheses onto General Propositions ………………….118 7 The Effect of Policy Interventions on Tobacco Consumption in the European Union, 1970-2000…………………………………119

8 The Effect of Policy Scope on Tobacco Consumption in the European Union, 1970-2000……………………………………….125

9 The Effect of Policy Scope on Tobacco Consumption in the European Union when Tobacco Manufacturing is High/Low, 1970-2000...............................................…………………………..127

10 Supranational Directives for Tobacco Control Adopted by European Union……………………………………………………135

11 The Effect of Policy Scope and Policy Environment Factors on Tobacco Consumption in the European Union when a Supranational Policy Mandate for Tobacco Control is in Force, 1970-2000………………………………………………………….150

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CHAPTER I

INTRODUCTION

Tobacco Control in the European Union

Over the past thirty years tobacco consumption and control have been of

political, social and economic interest. Across the developed world, considerable

political conflict over tobacco control has been generated regarding regulation, taxation,

consumer protection, and public health (Studlar, 2002). Cigarettes have become the

target of national sin-tax policies, production and manufacturing of tobacco has been

under scrutiny, and there has been an increase in the distribution of scientific

information linking tobacco consumption with numerous health conditions, including

several cancers ending in death (for example, 1964 U.S. Surgeon General’s Report and

numerous European white papers between 1995-2005). Socially, cigarette smoking has

been labeled a nuisance among patrons of private establishments as well as by

employees and visitors of public venues such as parks, trains and government buildings.

The result has been an explosion of policies to govern the harmful effects of

environmental tobacco smoke (ETS) in social environments, both public and private.

These developments have changed the political and social discourse surrounding

___________

This dissertation follows the format of the American Journal of Political Science.

2

state regulation of harmful commodities which put public health at risk. Specifically,

they have given rise to comprehensive plans of action to curb smoking, in particular,

across the European Union. These plans have both member state and supranational

origins.

A number of commissioned studies from international organizations (e.g., the

World Health Organization and the World Trade Organization) have also been catalysts

for igniting discourse on measures for reducing smoking among various target

populations. Their efforts include outlining proposals for abolishing tobacco advertising

and promotion, altering public attitudes towards smoking, preventing tobacco

smuggling, and supporting research on the harmful effects of tobacco smoke (European

Ministerial Conference, 2002; European Commission on Public Health, 2006). For these

reasons tobacco politics remains highly salient to citizens, politicians and those in the

tobacco industry across Europe.

From a public health and economics perspective, the expanding list and

incidence of tobacco-related cancers and diseases across Europe in the last three decades

also add to existing fiscal healthcare costs facing over-extended, traditional welfare

states. These pressures provide another impetus for member state governments across

the European Union to engage in regulating tobacco as an addictive, dangerous

commodity. Many of these control efforts require collaborative action between multiple

levels of governemt, local businesses, and mass publics for successful adoption,

implementation, and compliance. These are reasons why tobacco control has political

and policy significance.

3

Purpose of Project

The purpose of this project is to examine the politics of tobacco, expressed

through public policy, to understand why certain interventions work better than others in

curbing the tobacco epidemic. I use a combination of three research approaches

commonly employed in policy studies: substantive policy area analysis, quantitative

historical (over-time) analysis, and quantitative cross-sectional analysis. The project is

comparative, focusing on cross-national policy effectiveness in member states of the

European Union. The focus on European Union develops implications of regulating

tobacco in a multilevel governance environment. I develop an instrumental theory of

policy effectiveness to gauge the comparative impact of tobacco control efforts.

Analyses are both descriptive and prescriptive in nature.

I begin the project in Chapter I by situating my research against the policy

problem of tobacco consumption. I discuss how the combination of policy research

approaches can be applied to this policy problem. In Chapter II I establish how to study

tobacco policy effectiveness from an instrumental view, drawing on three bodies of

literature: regulatory policy effectiveness, tools of government action, and frameworks

of policy typology. I develop conceptual clarity as to how tobacco control interventions

can be classified according to type and behavioral attributes. Chapter III examines

government action on tobacco control from 1970-2000 across fifteen countries in the

European Union: Austria, Belgium, Denmark, Finland, France, Germany, Greece,

Ireland, Italy, Luxembourg, Portugal, Spain, Sweden, Netherlands, and the United

Kingdom. I add to this historical account empirical evidence in support of how tobacco

4

policy instruments often converge on common underlying notions of command-control

regulation and incentive-based interventions which rely on quality information.

Using a historical perspective, I catalog 1) the adoption of tobacco legislation and

2) the use of individual policy instruments within each legislative occurrence, for all

member states. This descriptive analysis also illustrates how the inventory of common

instruments (policy scope) has expanded over time. Chapter IV is a quantitative analysis

of the effectiveness of both individual and multiple policy instruments at the member

state level. Policy is generally envisaged as a governance mechanism, and an

instrumental framework for comparative effectiveness is applied to testing hypotheses

concerning how policy outcomes respond to various policy efforts when the policy

environment (bureaucratic, political, interest group and contextual factors) is considered.

Finally, I evaluate whether policy effectiveness remains robust to strategic positioning

by prominent actors in the policy environment.

Chapter V extends Chapter IV by empirically testing whether Europeanization

plays a role in constraining or enabling tobacco control policies at the national level.

Two institutional features of the European Union are identified as critical for policy

performance related to tobacco control: 1) the way in which EU tobacco directives are

integrated into national law and lead to harmonization across countries 2) the function of

policy mandates within a supranational system of policymaking. I supply direct and

indirect evidence to support claims of how Europeanization has shaped the tobacco-

policy environment at the national level. Finally, Chapter VI offers substantive and

5

theoretical conclusions articulating the contribution of this project to the study of

comparative public policy.

I argue throughout the study that public policy is one expression of the

relationship between government and its citizens; it helps negotiate governance between

state and society. As such, this study speaks to a larger discourse on democracy and

public policy (Schneider and Ingram, 1997; Ingram and Mann, 1980), especially policy

effectiveness. An instrumental theory of policy effectiveness inherently values policy

performance – holding government accountable for gains and losses associated with

policies and programs being pursued. This is the force behind considering policy

outcomes as the dependent variable of interest throughout the study. Furthermore, the

selection among policy instruments and the complex political economies surrounding

subsequent policy systems may have implications for broader democratic governance.

Concentrating on the regulation of tobacco across Europe is a gateway to confront these

larger questions and concerns over the role of policy in facilitating democracy in the

modern state.

Policy Problem

The problem of tobacco consumption is multifaceted. National and regional anti-

tobacco movements have increased their presence across Europe, industry alliances have

become organized and powerful and normative concerns over the taxation of cigarettes

to generate government revenues have surfaced. Progressive, pro-health interest groups

have undertaken efforts to overwhelm positive images of smoking by injecting counter-

6

campaigns which tout the harmful health effects of tobacco consumption of any kind,

but especially smoking (World Health Organization, 1997). As expected, the tobacco

industry has responded using direct and indirect means to influence policymakers,

including forging alliances with member states who are amenable to preserving industry-

rights to grow, produce, manufacture, and sell tobacco products for maximum profit

(Germany, as example) (Aspect Consortium, 2004) . These alliances have influenced the

degree to which national tobacco policies constrain their actions. They have also

reinforced the determination of the tobacco industry to become highly integrated into the

policymaking process. These activities are part of a larger global strategy to expand

tobacco-markets in those directions with least regulatory resistance (e.g., Central Europe

and East Europe, East/South East Asia). With the support of legislation providing legal

grounds for costly litigation in the United States, those in the industry are also protecting

their interests against such a fate in Europe and in markets reaching the developed world

(Rabin, 2001).

More generally, economic consequences of controlling tobacco, as well as citizen

and industry responses to regulation, face political actors to various degrees, cross-

nationally. Policymakers at all levels are making crucial decisions on the level of

national-commitment towards intervening in the marketplace when public health is at

risk (Meier and Licari, 1998). At the least, there is a rising consciousness of the

importance of controlling tobacco, especially cigarettes, in the minds of decision makers.

At the most, the result is a rise in tobacco control generally and an overall expansion of

7

tools used by government to change the initiation and consumption behavior of target

populations (for example, taxation, information, and command-control tools).

Another facet of the policy problem deals with the complexity of economic,

health, and psychological determinants of cigarette smoking. The demand for cigarettes

has become increasingly inelastic to price increases due to its addictive qualities (Licari,

2000). This has made cigarette taxation attractive as a source of governance revenue, but

has sent mixed signals to the public as to whether these actions are exploitive in nature.

It is questionable whether these policies are pro-health and whether they disadvantage

poorer segments of the consumption population, who typically have limited access to

cessation treatments. Finally, tobacco consumption has been historically socially-

constructed as acceptable in some time periods, like most of the twentieth century and

during wartimes, and as increasingly unacceptable in others, such as the post-1964

Surgeon General’s Report era (Rabin, 2001). Decoupling tobacco control policy from

evolving social constructions of cigarette smoking is not reasonable. Any contemporary

study of policy effectiveness in this arena should acknowledge this shifting context, as it

helps illuminate the present focus on improving public health.

The concern over public health is especially poignant for European states with

large social welfare dependencies. This concern is exacerbated by the half million

European Union citizens who die due to tobacco-related illness every year, and more

than triple that amount who suffer from tobacco-related diseases (Aspect Consortium,

2004). Despite these statistics, policy actions did not begin taking shape through

legislation until the mid 1980s and early 1990s at the member state level. Initiation of

8

tobacco control from the supranational level did not commence until 1989. The first

formal authoritative mandate to control tobacco consumption was introduced in the

Treaty of European Union (TEU). This document was the first official coordinated effort

outlining a commitment to protect the health and safety of European Union citizens by

engaging in tobacco control, with the primary goal of curbing consumption of products

resulting in adverse health effects, or death.

Cigarette Consumption in Europe 1970-2000

Focusing on tobacco control across member states provides a great deal of

variation in tobacco consumption and tobacco control policies. Figure 1 illustrates mean

cigarette consumption (number of cigarettes per capita, annually) across Europe during

the decade 1970-1980, by country. The overall range of cigarettes consumed across each

European country during this decade is between 1250 (Portugal) and 2400 (Greece)

cigarettes per capita, annually. Greece, the United Kingdom, and Ireland are Europe’s

highest cigarette consumers, while Sweden, Finland, and Portugal consume,

on average, one thousand less cigarettes per person than the three consumption leaders.

Overall cigarette consumption (mean consumption) in European countries is

approximately 1300 cigarettes per person, annually, in the decade of 1970-1980.

9

FIGURE 1 Average European Cigarette Consumption, Number of Cigarettes Per Capita, Annually: 1970-1980

0 500 1,000 1,500 2,000 2,500mean of cigcons

PortugalFinland

SwedenItaly

FranceDenmark

SpainAustria

NetherlandsGermanyBelgium

IrelandUnited Kingdom

Greece

Mean Cigarette Consumption

Source: World Health Organization – Health for All Database (2004).

In the decade of 1980-1990, Figure 2 demonstrates that overall consumption

(mean consumption) across European countries rises to approximately 1700 cigarettes

per capita, annually, from the previous decade. Also, the overall range of consumption

across Europe widens to between 1300 per person (Netherlands) to 3000 (Greece). The

United Kingdom and Ireland are replaced by Spain and Belgium as European

consumption leaders, per capita. Finland and Sweden, however, remain the lowest

European cigarette consumers.

10

FIGURE 2 Average European Cigarette Consumption, Number of Cigarettes Per Capita: 1980-1990

0 1,000 2,000 3,000mean of cigcons

NetherlandsSwedenFinland

PortugalDenmark

FranceUnited Kingdom

ItalyIreland

GermanyAustria

BelgiumSpain

Greece

Mean Cigarette Consumption

Source: World Health Organization – Health for All Database (2004).

Figure 3 demonstrates how average cigarette consumption varies for many European

states compared to the previous decade, with some countries reporting substantial

decreases in consumption ( Sweden, Finland, Belgium, and Italy), while others report

increases (Spain and Netherlands) or stationary levels (Austria, France, United

Kingdom, and Denmark) of cigarette consumption per capita.

11

FIGURE 3 Average European Cigarette Consumption, Number of Cigarettes Per Capita: 1990-2000

0 1,000 2,000 3,000mean of cigcons

SwedenFinland

DenmarkItaly

United KingdomFranceAustria

PortugalGermany

NetherlandsIreland

BelgiumSpain

Greece

Mean Cigarette Consumption

Source: World Health Organization – Health for All Database (2004).

Taken together these figures demonstrate how cigarette consumption varies

across both time and space in Europe from 1970-2000. I explain this variation using

measures of different policy instruments, as well as relevant factors in the policy

environment.

Finally, political scientists care about this policy issue for a number of reasons.

Tobacco control activities are among the first non-economic regulatory efforts by the

European Union towards mixed social-regulatory arenas. This progression corresponds

with goals introduced in the Treaty on European Union (1992), which introduced

12

guiding principles and operating rules to achieve economic, political, and social union.

Secondly, even with mounting studies linking adverse health consequences to smoking

over the past two decades, it remains unclear how tobacco can be controlled. This raises

salient political questions as to the purpose and effectiveness of various tobacco control

policies across member states and at the supranational level, over time.

Research Orientation for Tobacco Control

Substantive Case Study

This dissertation combines three research approaches to investigate the

effectiveness of tobacco control policy in the European Union: substantive case study,

quantitative historical analysis, and cross-sectional analysis. Taken together, these

approaches inform a comprehensive model of comparative public policy which can be

exported from the tobacco-health arena to other hybrid, social-regulatory policy areas,

including regulating the environment, family planning, stem-cell research, and nuclear

waste disposal. Hybrid regulatory areas, such as these, inherently require attention to

both social and economic concerns by policymakers. This dual-feature is often what

makes them politically salient (Durant and Legge 1993).

By focusing on tobacco control as a substantive policy arena, I am able to answer

three important questions: 1) how can tobacco policy instruments be identified,

categorized, and analyzed? 2) which factors in the policy environment enable or

constrain the success of individual and multiple policy efforts? 3) how, and to what

13

extent is policy performance contingent on factors associated with multilevel

governance?

The first question introduces the theoretical orientation of the project, which is

based on an instrumental view of public policy. Identification and categorization of

policy instruments shape the foundation of this perspective. First I develop a strategy for

identifying tobacco policies. Across Europe, tobacco policy activities typically have

their origins in national policy initiatives. Therefore, I rely on national legislative action

to identify policies. Secondly, I draw on the policy tools literature (Salamon, 2002;

Schneider and Ingram, 1990; Meier and Licari, 1998; Studlar, 2002) to categorize

instruments of tobacco control evident across national legislation, according to whether

they focus on advertising restrictions, taxation of tobacco products, and/or regulation of

environmental tobacco smoke, for example. These categories are refined further

according to their attributes – whether they are command-and-control in nature,

incentive-based, or designed to correct information asymmetries in the market.

Ultimately, an instrumental perspective a) improves the exercise of comparing policies,

cross-nationally and b) supplies expectations of potential relationships between policies

and outcomes, in the form of testable hypotheses.

This information can then be used to address the second question: which factors

in the policy environment enable or constrain the success of individual and multiple

policy efforts? This question raises three main points relative to the study of public

policy: First, evaluating individual policy effectiveness is only useful to the extent that

no other policies exist targeting the same outcome. Secondly, since we rarely observe

14

such an occurrence in the context of tobacco control, the effectiveness of any particular

policy must be considered in light of the existing regulatory context (Durant and Legge

1993). An instrumental approach takes into consideration both the effectiveness of any

single policy, warning labels on cigarettes or advertising bans for tobacco, in light of

existing policies or simultaneously-adopted policies. Thirdly, identifying relevant factors

in the policy environment is important for understanding how effectiveness is either

constrained or enabled by bureaucratic, political, interest group, and robust-contextual

factors.

In addition to these, macro-structural factors which fundamentally change policy

development and implementation should be considered, including an examination of

how policy performance is affected by supranational features arising from the multilevel

governance arrangement of the European Union. These features include the extent to

which integration forces lead to policy convergence across member states, as well as

how supranational directives are incorporated into national policies. The way in which

member states integrate directives into national legislation, for example, can have

demonstrable effects on policy outcomes (Knill and Lehmkuhl, 2002). Establishing

incentives for member state compliance at the supranational level, as well as instituting

standards of suprastate-commitment to certain policy imperatives may also have

implications for policy performance across the EU. These types of issues should be

considered when gauging how Europe matters to policy performance in the EU system

writ large.

15

Answers to these questions provide the foundation for a more generalizable,

comprehensive, and comparative approach to evaluating policy performance in a system

of multilevel governance. The substantive policy arena of tobacco control is also

appropriate for exploring these questions like these, generally, due to the prevalence of

tobacco consumption, and its subsequent control, across every level of government in

the European Union and around the world.

Quantitative Historical Analysis

The second research approach is quantitative historical analysis. This approach

provides a way to think about the influence of time and space when determining the

effectiveness of public policy. Social regulatory policies are interventions. These

interventions can represent new, innovative actions, the reinforcement of past actions, or

the rescinding of policy activities from the legislative docket. The only chance of

capturing these dynamics, and how they influence outcomes, is to look at their

occurrence over time. Tracking new policy interventions while also accounting for the

continuation of existing policy requires a historical investigation. Having a dataset with

an over-time dimension provides the necessary mechanism for disentangling those

factors which influence policy outcomes and it captures the dynamic nature of policy

effectiveness.

Taken together, the first two research approaches bring one closer to a theoretical

and empirical understanding of how to compare public policy and gauge overall

16

effectiveness. To explain why tobacco control works in some instances and not others, a

third stream of analysis is needed: quantitative cross-sectional analysis.

Quantitative Cross-Sectional Analysis

It is especially important to consider cross-sectional variation when studying

public policy. Cross-sectional analysis of countries which share a historical context and

similar attributes allows for leverage in exploring the relative impact of factors which are

likely to vary across space, such as bureaucratic, political, interest group, and robust-

contextual factors relevant to controlling tobacco. Quantitative cross-sectional analysis

in tobacco control is limited to U.S. states and some U.S. cities (Shipan and Volden,

2006; Meier and Licari, 1998), as well as across several OECD countries (Licari, 2000).

The field is wide-open for analyzing member states of the European Union.

Taken together, these three research approaches provide an anchor for the

investigation of research questions throughout the dissertation. While each approach is

individually important, a comprehensive strategy utilizing all three is necessary for

better grasping the effectiveness of tobacco control in European Union. The first step in

implementing this strategy is to show how my research combines with and contributes to

existing tobacco control studies in the literature.

17

CHAPTER II

RESEARCH ORIENTATION FOR TOBACCO CONTROL

Tobacco Control in the Literature

The political significance of tobacco control has been expressed a number of

ways in the literature. Tobacco control studies in political science address a number of

different research questions and utilize a variety of theories. Most research focuses on

the United States as a case, with limited attention to comparative U.S. states (Licari,

1997; Meier and Licari, 1998). More recently, qualitative comparative research has been

conducted on tobacco control at the U.S. state-level and Canadian provincial-level (see

Studlar, 2002). In this study, federalism, policy transfer, and interest group factors

influence adoption patterns of tobacco policy at the sub national and federal levels of

government. Less attention has been paid to cross-national comparisons outside of these

cases and it is rare to find a discussion on policy outcomes, rather than policy outputs.

These deficiencies in the literature are addressed in this dissertation.

There are two main political orientations to the study of tobacco control. The first

deals with political input processes in policymaking. This research focuses on the

following question: What determines tobacco control policy? The level of analysis is

often federal, but in some cases reaches to the sub national level. Four theoretical

approaches are used to explain tobacco control policy: agenda-setting theory, interest

18

group/social movement theory, theories of partisanship and ideology, and political

institutions.

Agenda-Setting and Tobacco Control

The main contribution of research using agenda-setting theory to explain tobacco

control policy is its ability to clarify difficulties associated with defining the “tobacco-

problem” over the years. Agenda-setting theory is used to explain why governments act

as they do on policy issues (Studlar, 2002). Baumgartner and Jones (1993) find their

agenda setting theory explains tobacco control policy over time via the changing policy

subsystem, dynamic problem definition, and role of policy entrepreneurs (see also Spill,

Licari, and Ray, 2001). Other agenda setting studies suggest that non governmental

experts and public health social movements have moved tobacco policy onto the

political agenda using outside initiatives (Cobb, Keith-Ross, and Ross, 1976). This

observation is consistent with efforts made by public health interest groups to demand a

more pluralist approach to curbing the tobacco epidemic – as opposed to the traditionally

elitist initiatives coming from government officials who are often economically and

politically connected to pro-tobacco communities (Cobb and Elder, 1972; Downs, 1972;

Studlar, 2002). Despite these efforts the tobacco industry still exercises a great deal of

influence in many political decision making spheres. This is due in part to the long-

standing comparative advantage they maintain with organizing in pluralist systems of

governance versus other anti-tobacco groups.

The agenda setting approach also emphasizes the role of entrepreneurial politics

(Wilson, 1990), where “politically ambitious or morally committed leaders employ

19

modern techniques of mass communication to propose measures in the public interest,

reframing the way in which social problems are perceived and talked about” (Rabin and

Sugarman, 2001 p. 13). In tobacco politics, this tactic has proven to be essential to the

movement of tobacco concerns from the informal to the formal, systemic policy agenda,

at the federal level in the United States (Baumgartner and Jones, 1993). This strategy has

helped foster a litigation environment in the U.S. that is hostile towards the tobacco

industry. These developments provide rather strong incentives for tobacco companies to

seek markets elsewhere, particularly in areas with the least regulatory constraint and

more favorable litigation atmosphere.

Comparative research on tobacco politics between the U.S. and Canada

constructs a division of historical periods useful for examining tobacco control policy

(Studlar, 2001). This is a useful heuristic which gives context to policy discussions and

also incorporates important historical information unique to the units of analysis under

observation. I use this strategy to help build a case for supranational influence over

national tobacco consumption outcomes. Despite contributions made by agenda-setting

theory to tobacco control, few applications of the theory have been linked to policy

performance (Gilmore and McKee, 2004; Rabin and Sugarman, 2001; Studlar, 2001).

Social Movements, Interest Group Conflict, and Tobacco Control

The second theoretical approach within the political input-process orientation

deals with social movements and interest groups. This literature burgeoned in response

to efforts by public health advocates to organize themselves into a more active

20

relationship with government. One goal of this movement in U.S. and Canadian cases

was to break apart robust policy subsystems build around the tobacco industry and its

protection. The idea was to use collective action to promote more pluralist, pro-health

support while simultaneously weakening pro-tobacco elitism.

The outside-initiative exercised by interest groups and social movements began

to contend with long-standing paths of influence secured by the tobacco industry within

critical spheres of policymaking. Nathanson (1999), for example, demonstrates how

social movements act as catalysts for changes in smoking policy . Building on previous

research Nathanson argues that policy success attributed to health-related social

movements coincide with credible social and scientific threats to public health, the

ability to mobilize a diverse, organized constituency, and the convergence of political

opportunities with target vulnerabilities. The presence of such factors bolsters policy

change in a direction towards public health protection and away from tobacco and

agricultural protectionism.

Similar to groups in the environmental movement, anti-tobacco interest groups

share a normative commitment to protect public health while offering their expertise and

competency to policy entrepreneurs with respect to scientific and social information

(Baumgartner and Jones, 1993). In the U.S. , policy entrepreneurs played a key role in

representing anti-tobacco interest groups as epistemic communities to key policy makers

(Wilson, 1990; Hays, 1996), emphasizing how the tobacco-problem should be reframed

according to risks associated with cancer, disease and second-hand smoke (Rabin and

Sugarman, 2001). These actions are commonly reflected in policy outputs over time.

21

Generally, interest group and social movement perspectives consider tobacco

control an area stimulated by attentive subsets of the public, whether they are interest

groups, social movements, or advocacy coalitions (Studlar, 2002). Explanations of

tobacco policy using interest group and social movement theory emphasize the dynamic

goals of groups, their relative power to alternative interests, and their formal institutional

connectivity which is most likely through a policy subsystem. Missing from this

perspective is the role played by institutions in shaping interest-group integration into

national policymaking processes. I address this deficiency while also linking institutional

features to policy outcomes.

Partisanship, Ideology and Tobacco Control

Another perspective taken by political scientists to explain tobacco policy deals

specifically with political elites and their partisanship and ideology. Tobacco control is

not typically considered a high-politics issue (Studlar, 2002). Most politicians do not

incorporate a stance on tobacco issues in their formal policy statements when

campaigning and political parties do not customarily include such stances in their party

platforms. Cross-national comparisons between the U.S. and Canada reveal that no

political parties have made tobacco control a major electoral issue (Studlar, 2002). As

such, most partisan and ideological conflict over tobacco issues is likely to occur in the

policy subsystem environment rather than the political forefront. Exceptions are firmly

grounded in historical context. For example, the rise in tobacco-related litigation at the

U.S. state-level is partially attributed to attorneys general partisan identification and

22

ideological leanings. Spill, Licari, and Ray (2001) find systematic evidence that

Democratic attorneys general are more likely to file lawsuits against the tobacco industry

than their Republican counterparts. The explanation for this relies on understanding the

historical link between tobacco issues and political party support by the tobacco industry

in the United States.

In a comparative context, it is possible to imagine how any stance taken by a

political party on tobacco issues might be strongly reinforced by features of party

discipline and accountability that often exist in parliamentary systems of government.

Political parties, however, rarely take such stances and when they do it is difficult to

attribute their position to general partisanship and ideology (Studlar 2002).

Political Institutions and Tobacco Control

A more promising approach to explaining tobacco control policies across space

and time involves political institutions. Institutional theory is used to explain tobacco

policies by focusing on how governmental rules of the game influence policy output.

This primarily includes the way government is structured and how policy is decided

(Studlar, 2002). This approach also permeates agenda setting and social movement

theories, by structuring the way factors inside and outside government influence tobacco

control and policy change.

In western developed democracies, qualitative evidence suggests that tobacco

policymaking, specifically, occurs at the legislative, executive, judiciary, and

bureaucratic levels of government (Aspect Consortium 2004). For scholars searching for

23

explanatory factors of tobacco policy output, this is a relatively unexplored area in the

European context. This is surprising given the rich structural variation across national

governments within the European Union. Points of variation relevant to tobacco control

are the organization of legislative and executive systems, the constitutionally defined

system of power between institutional bodies (Kagan and Vogel, 1993; Studlar, 2002),

the degree of horizontal and vertical fragmentation of political activities, bureaucratic

policymaking and enforcement styles (Weaver and Rockman, 1993), and the

organization of court systems.

Institutional theory is also relevant for establishing how interest groups are linked

to government and policymaking. This particular linkage is important since the tobacco

industry and anti-tobacco movements have had varying degrees of interaction with

governmental units over time which may produce varying results for policy

performance.

Tobacco constituencies are also connected to governments in various ways. In

some countries certain institutional bodies are more connected to the tobacco industry or

public health movement than others. These differences are likely to influence the shape

of tobacco control legislation. Studlar (2002) provides a comparative case of this

theoretical expectation:

“In Canada, once tobacco control is placed on the formal parliamentary agenda,

any legislation or budget proposals are highly likely to pass in a form closely resembling

the original unless the Cabinet chooses to accept changes or allow the bill to die. Thus

policy responsibility is clearly in the executive even though the tobacco constituency

24

linkages of federal MPs are very similar to those in the United States. Twelve percent of

the members of the House of Commons had an industry or agriculture presence in their

district in 1996, almost identical to the rate in the US House of Representatives (Ashley

et al., 1997)…This same institutional responsibility for tobacco-control legislation has

been allowed to wither…due to insufficient commitment by the executive of the

governing party although it may be influenced by its legislative party caucus behind

closed doors. Tobacco company connections to the executive in Canada, less publicly

observable…explain [the] tardiness of [restrictive tobacco-control policies] (p. 262).”

Hypotheses generated in this research suggest that an increased tobacco presence

(and thus, tobacco constituency) in a country might decrease the likelihood of restrictive

policies that harm constituents. I incorporate a test of this hypothesis in Chapter IV.

Refocusing the same hypothesis on anti-tobacco constituents is not likely to make sense

given their weakness in organizing compared to the tobacco industry (Nathanson, 1999;

Licari, 2000).

There is a major shortcoming with applying institutional theories to tobacco

control. There is an assumption that general institutional features can be easily and

specifically linked with stances on tobacco issues and formation of tobacco policies.

These linkages are difficult to track unless the researcher is focusing on a very narrow

part of the puzzle. A larger piece of the puzzle is explored in this study. In order to

convincingly use institutional theories, I rely on substantive information coming from

the policy context, recognizing possible limitations.

25

Policy Typologies, Diffusion, Instruments and Tobacco Control

The second political orientation to the study of tobacco control progresses from

input-policymaking processes (agenda-setting, social movements, interest group conflict,

partisanship, ideology, and political institutions) towards explanations of how policy

outcomes respond to tobacco control efforts. Systematic investigations of policy

outcomes in the literature are less comprehensive, less developed, but extremely fertile

as a research area. I contribute to this portion of the literature.

There is growing concern over how responsive target populations are to

government action. This concern is based on a number of factors. First, those who are

targeted by particular policies may disagree with the instrument of regulation. Some

private businesses such as cafés and bars have not been in favor of abrupt, mandatory

smoking bans because of how disruptive they are to clientele-expectations and business

norms. On the other hand, there has been less resistance towards voluntary bans and

phased-efforts to ban smoking because they allow for adjustments over time.

Secondly, the target population may hold a certain preference or attitude towards

what is considered acceptable in the arena of government intervention. If there is some

distance between attitudes and regulatory efforts, there may be resistance to comply.1

Thirdly, the target population may not be in position to respond to government action.

1 I am not able to empirically investigate the role of public opinion in tobacco control given data limitations. However, I do incorporate qualitative information relevant to this concern throughout the study where appropriate.

26

Given that many tobacco products contain nicotine, addiction plays an important role in

whether someone is able to adjust their consumption, despite government regulation.

All of these factors may influence the success of government action directed

towards reducing consumption of tobacco products. They can also be linked to three

theoretical perspectives used to explain policy outcomes: policy typology, policy

diffusion, and policy instrument theory.

Policy typologies are somewhat descriptive in nature, but can also give rise to

theoretical expectations linked to outcomes. For example, policies adopted by

legislatures have long been divided into three major types: regulatory, distributive and

redistributive (Lowi, 1964). These typologies “differentiate policies by their effect on

society and the relationships among those involved in policy formation” (Anderson,

2000).2

Regulatory policies limit the discretion to act of the regulated by imposing

restrictions or limitations on certain behavior (Mitnik, 1980). Regulatory efforts are

inclusive of general guidelines that are often expanded into specific actions. Lowi (1972)

argues that regulatory policies are successful depending on whether government

coercion is remote or immediate and whether a distinctive pattern of pluralist

participation allows for appropriate management of policy. Command-control policies,

such as restrictions on cigarette ingredients represent an example of ‘immediate

2 Policy typologies become linked to outcomes when there is a focus on differentiating policies by their effect on society.

27

coercion’. These policies specify sanctions or penalties for noncompliance and establish

oversight capabilities.

Distributive policies are “government efforts to distribute benefits to some

portion of the population and pay for those benefits from general tax revenues rather

than with user fees” (Meier, 1993). Lowi (1972) contends that distributive policies,

especially subsidies, transfer a more remote likelihood of government coercion. The

coercive element of subsidies is indirect or is displaced onto the general revenue system.

On the other hand, distributive policies can promote patterns of elite participation in the

policymaking process, leading to capture by the regulated (Lowi, 1972). This argument

is salient in the evolution of tobacco control in Canada and the U.S. The promotional

phase of tobacco control in these contexts was distributive in nature. During this time,

governments allocated subsidies to tobacco agriculture and refrained from creating

restrictive policies on manufacturing and consumption (Studlar, 2002). This era of

distributive policymaking helped forge a culture of government support for tobacco that

has been difficult to penetrate as time continues. These developments can be applied

reasonably well in Europe, especially given extensive national and supranational (e.g.,

CAP subsidy programs) commitments to certain agricultural commodities, including

tobacco in places like France, England, Germany and Greece.

Redistributive policies are more likely to incite political conflict. In redistributive

policy the government provides benefits for a portion of the population and requires

another group to pay for these benefits (Anderson, 2000; Meier, 1993). These policies

reallocate money, rights, power or values (Anderson, 2000). A recent trend in tobacco

28

taxation reflects how redistributive policies can work in large welfare states. Across

several European countries more than fifty percent of the price of a pack of cigarettes is

actually taxation of some kind (Chaloupka and Warner, 1999). Many of these same

countries are developing specific outlay accounts for these tobacco taxes which are

designed for recuperation of past and on-going health care costs related to the

management of smoking-related diseases among their citizens (Aspect Consortium,

2004). These actions reflect the reallocation of resources from cigarette consumers to the

state for the purpose of relieving the health care burden. These actions may be more

symbolic than pragmatic or realistic. There is mixed evidence whether tobacco taxation

yields enough revenue to cover such expenses (Chaloupka and Warner, 1999).

All three types of policies (distributive, regulatory, and redistributive) are evident

in tobacco control across the United States, Canada, and the European Union.

What do policy typologies contribute to an explanation of cross-national

variation in responses to tobacco control? First, the most important contribution is that

government intervention into public health and the consumer market place - whether

distributive, regulatory, or redistributive – fundamentally changes the basic equation of

tobacco consumption equals market-price plus individual choice. With the expansion of

tactics used by the tobacco industry both in and out of the political arena to protect their

interests, it is necessary for government actions to be wider in scope (e.g., regulatory,

distributive, and redistributive) and more severe in nature (i.e., more bans and

prohibitions than voluntary agreements) in order to have maximum influence reducing

cigarette consumption.

29

Secondly, policies which provide for more immediate government coercion are

likely to be successful in moving outcomes in a favorable direction. Finally, distributive

policies may capture the protectionist history between governments and the tobacco

industry, while also offering an account of how that history has shaped the way in which

the tobacco industry has positioned itself in policymaking processes and larger national

economies across European countries. Tobacco consumption may be unlikely to decline

under these circumstances.

Policy Diffusion and Tobacco Control. Policy outcomes may also be influenced

by the diffusion of policies across time and space. 3 There are three reasons

intergovernmental diffusion takes place. First, countries learn from one another about

what does and does not work. Secondly, there may be motivation to compete with one

another on improving outcomes in a particular area. Thirdly, public and political

pressures may force the adoption of policies taken by adjacent governments, or those

with similar characteristics (Berry and Berry, 1999).

The internal political climate and pressures from the external environment also

reveal something about how likely policies are to succeed once they are adopted. For

example, policy diffusion and subsequent success is predicated on the need for policy

involvement in the first place (Feiock and West, 1993; Ringquist, 1994) the degree of

interest group support around the issue (Dye, 1966; Hofferbert, 1974; Erikson et al,

3 Policy diffusion theory also explains policy adoption. The link to outcomes is a result of how policies are adjusted to account for context.

30

1989; Ringquist, 1994), the extent to which public and political support is present

(Berry and Berry, 1999), and the amount of implementation resources available for a

given intervention (Jacoby and Schneider, 2001; Daley and Garand, 2005).

Policy diffusion between member states in the European Union is typically based

on a voluntary mode of governance centered on persuasion (Bulmer and Padgett 2005).

More coercive variants of policy diffusion apply to decisions negotiated between

member states and supranational institutions, especially those dealing with policy

competencies covered in major treaties (Nugent 2001; Bomberg and Peterson 1999).

While I cannot create a valid measure capturing policy diffusion of tobacco control

across European countries due to data limitations, I am able to export from this literature

a number of expectations concerning the types of support necessary for policy success:

a) Interest group influence. There are two main interest groups contending for

influence in the tobacco control arena: the tobacco industry and public health

groups. Since the tobacco industry is smaller and more organized, they have

comparative advantage when competing for influence than more loosely formed

public health groups, during the time under investigation (1970-2000). I consider

two possible aspects of the interest group environment in shaping tobacco

consumption in Europe. First, I speculate outcomes are less favorable is those

countries where the tobacco industry has positioned itself as an important

contributor to the larger economy. This is based on the assumption that states are

not likely to pursue policies that compromise their macro economic position, on

any front. If the tobacco industry has established economic reliance between

31

themselves and the state, it is not likely that policy outcomes will move in the

direction of decline since the regulatory environment favors the interests of the

tobacco industry.

Secondly, outcomes may be less favorable in those countries where there

exist institutions enabling certain interest groups to participate in and exercise

influence over policymaking. The tobacco industry is not formally represented in

peak organizations of corporatist interest group institutions (Lijphart, 1999) in

European countries. Therefore, they rely on more pluralist institutional

arrangements for opportunities to exercise influence in policymaking. I speculate

policy outcomes are less likely to decline in countries with pluralist interest

group structures. This is based on the assumption that the tobacco industry

exercises a comparative advantage in organizing given their resources, over other

loosely organized groups competing for influence in similar arenas. I explore the

following propositions reflecting these considerations:

Proposition 1a:4 Policy outcomes are unlikely to decline in those countries

where the tobacco industry has positioned itself as an

important contributor to the larger economy and has

established its economic relevance to the government.

4 The term “policy outcomes” specifically applies to tobacco consumption in every proposition. When policy outcomes respond favorably this means there is a decline in consumption. If policy outcomes are unlikely to respond favorably this means they do not decline. I prefer to keep the propositions general in nature with respect to language used.

32

Proposition 1b: Policy outcomes are unlikely to decline in those countries

where the tobacco industry has the opportunity to exert

influence through pluralist interest-group structures.

b) Implementation resources. Comprehensive tobacco control policies are

expensive. They require scientific expertise to form standards of risk and safety,

stipulate that oversight be established to monitor compliance in a number of

disparate arenas, and they require wide-spread proliferation of information on the

dangers of smoking and general tobacco consumption. National bureaucracies,

particularly public health bureaucracies, often perform these core functions.

While there are other subnational participants involved in portions of these

efforts, their contributions are difficult to track.5 The public health bureaucracy

has the potential to develop and maintain a capacity for responsiveness in the

tobacco control arena. Therefore, I focus on the bureaucracy as an

implementation resource for controlling tobacco. I explore the following

proposition in light of these considerations:

Proposition 2: Policy outcomes are likely to decline in those countries

where implementation resources are available to support tobacco

control efforts.

5 When I track these contributions, in one way or another they typically lead back to governmental transfer of resources from national health bureaucracies.

33

c) Problem Severity and Need-Based Policy. The core problem with curbing

tobacco consumption is the addictive quality of tobacco products, especially

cigarettes. Over time, addiction can give way to smoking-related diseases, even

death. One way to capture the severity of the addiction problem is through

demand elasticity for tobacco products (Chaloupka and Warner, 1999; Meier and

Licari, 1998). When consumer demand is unresponsive to changes in price, a

degree of addiction is observed. Therefore, habit-persistence plays a key role in

determining future consumption. I explore the following proposition in light of

this consideration:

Proposition 3: Policy outcomes are unlikely to decline in countries where

addiction is more severe.

Propositions 1-3 represent how policy outcomes are contingent on interest group

influence, bureaucratic support, and robust-contextual factors.

Policy Instruments and Tobacco Control

Compared to more general typologies of regulatory, distributive and

redistributive policies, policy instruments reflect specific strategies for overcoming

impediments to policy-relevant action (Schneider and Ingram, 1990). Five broad

categories of policy instruments are identified by Schneider and Ingram (1990):

34

authority, incentives, capacity-building, symbolic and hortatory, and learning. Each

makes different assumptions about how policy relevant behavior can be fostered. For

example, target populations may not respond to calls for change if they believe the law

has not authorized certain actions, the proper incentives to respond are lacking, or the

severity of the problem and uncertainty around its solution are unknown. These

problems can be curtailed using policy instruments which provide authority, incentives,

or methods of learning (Schneider and Ingram, 1990). I investigate the following

proposition in light of these considerations:

This approach is used to identify and categorize tobacco control instruments in

the literature (Meier and Licari, 1998; Licari, 2000; Pal and Weaver, 2002; Studlar,

2002). In the U.S. context, Meier and Licari (1998) identify command and control

regulations, incentives, and information as three prominent and distinct tobacco control

instruments. They argue these instruments conceptually subsume those previously

proposed in the literature (for example Schneider and Ingram, 1990; Rose-Ackerman,

1995; Eisner, 1993).

Licari (2000) and Pal and Weaver (2002) condense tobacco instruments into

three categories that are slightly different than Meier and Licari (1998): command-

control regulation, taxation and education. The particular emphasis on taxation by these

authors reflects their focus on the role of demand elasticity in frustrating policy efforts

towards reducing consumption.

Studlar (2002) is the first to distinguish more carefully among instruments, rather

than focus on collapsing categories; in doing so, the complex reality of cross-national

35

government action on combating tobacco is captured. Five categories of tobacco

instruments are regulation, finance, capacity-building, education, and learning tools.

These categories also represent instruments introduced by previous scholars, such as

Schneider and Ingram’s (1990) capacity-building and learning tools, Meier and Licari’s

(1998) regulation, and Pal and Weaver’s (2002) taxation (here, finance). This system of

categorization is most appropriate for comparing U.S. and Canadian tobacco control

efforts. It is useful as a template for classifying tobacco control policies across the

European Union. In Chapter III I identify seven categories of tobacco control

instruments that can be organized according to how they overcome impediments to

policy-relevant action. These behavioral expectations are drawn from the policy

instrument literature, particularly Schneider and Ingram (1990). I explore the following

proposition in light of behavioral expectations offered by Schneider and Ingram (1990):

Proposition 4: Policy outcomes are likely to decline in those countries

where policy instruments overcome impediments to policy-

relevant action.

This general proposition includes exploration of more specific policy categories,

such as command-control policies and those designed to correct information

asymmetries and uncertainties. The impact of these instruments on policy outcomes

may also be dependent on factors coming for the supranational context.

36

Most supranational directives in the European Union are anchored by policy

mandates outlined in Union treaties. These mandates can influence national policies in

three important ways. First, they can establish policy competencies between the EU and

member states. This means some policy problems become the exclusive responsibility of

individual member states while others require collective action by all member states.

Secondly, these mandates create incentives for member state compliance with

supranational priorities while also conveying the degree of supranational commitment to

improving policy performance in certain economic, political and social arenas (Nugent,

1999). Finally, they can lead to harmonization of policy efforts across member states

which can create efficiency-gains in achieving policy goals. I explore the following

propositions in light of these considerations:

Proposition 5: Consumption is likely to decline when national efforts to

control consumption occur within a supranational context

of compliance and commitment to tobacco control, established

through policy mandates.

Proposition 6: Supranational mandates may lead to the harmonization of tobacco

control policies across member states. Consumption is likely

to decline in those countries where efficiency-gains are realized

through the harmonization process.

37

Developing an Instrumental Theory of Public Policy

The purpose of developing and applying an instrumental theory of public policy

is to provide explanations for why, and under what circumstances, some policies work

better than others in controlling tobacco consumption. The previous section presents four

components to this theory. A fifth component is added in this section.

First, a strategy is developed for identifying policies. Three key decisions are

made at this level: which functional policy area will be under investigation, which level

of government policymaking is most appropriate to target and which expression of

public policy (e.g., legislation, judicial decisions or bureaucratic rulemaking) captures

the policy activity of interest to the researcher.

Secondly, a theoretical strategy is used for categorizing policies. Policy

typologies provide general guidelines for distinguishing among policies. Information

from the specific policy context provides another way to group like policies into

categories. Thirdly, policies are characterized according to their behavioral attributes.

These attributes can be linked to outcomes, depending on whether they are authoritative

or command-control, as example. Fourth, the types of support necessary for policy

success are assessed. This includes a determination of how policy outcomes are

contingent on interest group influence, implementation resources and problem severity.

The fifth component provides a strategy for assessing how policy instruments

work in combination. Meier and Licari (1998) provide the only empirical study in

tobacco control of how information and price policies work in combination to influence

consumption. They develop, test and confirm a formal postulate that the combined

38

contribution of multiple policies can be less than the sum of individual policy

interventions due to different demand elasticities of the target population to which

policies are directed. I test this formal postulate in a comparative context and offer

another suggestion for analyzing combined policy efforts when the likelihood of

simultaneous policy adoption is high.

There are likely a number of policy interventions implemented at the same time,

across space. This makes collinearity in the estimation process difficult to overcome.

One strategy for reducing potential collinearity among policies while preserving as much

behavioral information across instruments as possible is to categorize policies according

to price and non-price policy bundles. Non-price policy bundles combine interventions

into one measure of policy scope. While some nuanced behavioral information is traded

away, the assumption is that the aggregate behavioral quality will enhance policy

outcomes as the scope of policy interventions increases. I test this extension of policy

effectiveness when instruments are used in combination. There may be implications

derived from this strategy for the general application of an instrumental theory of public

policy. For example, the theory may need to be applied differently depending on the unit

of analysis under observation, whether policies are studied cross-sectionally and whether

they are studied over time.

To conclude, Blair (2002) observed that policy tools affect policy outcomes in

predictable and regular ways since they represent the blueprint or template that shapes

policy. The purpose of developing and applying an instrumental theory of public policy

is to provide more specific explanations of these processes. Peters and Van Nispen

39

(1998, p. 35) add that “the policy world is very crowded and there are already multiple

instruments in place. This crowding means that any new intervention will have to

contend with, and be coordinated with, a number of other programs engaged in similar

and complementary tasks.” An instrumental theory of public policy provides a way for

considering these realities in the context of European tobacco control. Finally, this

approach also represents a response to Rabin and Sugarman’s (2001) observation that

the limited effectiveness of any single tobacco control strategy leads to a subsequent

multi-initiative approach to favorably influencing outcomes.

Specific hypotheses are derived from propositions (1-6) coming from this chapter

and are tested empirically in Chapters IV and V. New and existing policy efforts,

support from the policy environment and supranational factors are linked to policy

outcomes by way of an instrumental theory of policy effectiveness. In the next chapter,

legislative policy histories of fifteen EU member states are explored, categorized and

analyzed as part of the first step in the empirical investigation of how tobacco policy

instruments influence policy outcomes.

40

CHAPTER III

TOBACCO CONTROL EFFORTS ACROSS MEMBER STATES

Chapter I demonstrated that cigarette consumption varies greatly across time and

space. Chapter III explores policy explanations for this phenomenon. I present historical

information about the types of policy tools used to control tobacco across member states

of the European Union. The following descriptions of European tobacco policies

indicate which policy instruments are most commonly utilized, how the list of common

instruments has expanded over the last thirty years, and how national policy efforts work

to comply with European directives for controlling tobacco.

The chapter is organized in the following manner: First, individual policy

descriptions are given for each member state, regardless of member status at the time of

policy activation. Secondly, the relationship between non-price policy efforts and

demand for addictive commodities is articulated. Thirdly, tobacco policies are

categorized into a policy instrument framework and principal component analysis is used

to empirically investigate whether policies can be separated according to behavioral

attributes. The results are applied to empirical investigations in Chapter IV and Chapter

V.

Member State Policy Instruments

Tobacco legislation comes from two main sources: the World Health

Organization and the European Commissions’ Directorate-General for Health and

41

Consumer Protection. Shafey et al (2003) is an edited tobacco policy reference book and

part of the global data initiative of the World Health Organization. Other WHO

publications confirm policy legislation reported in Shafey et al (2003). The main

contribution of the European Commission is a report by the Aspect Consortium (2004)

which is part of the Directorate-General for Health and Consumer Protection for the

European Union. This publication also reports the implementation of tobacco policies

across member states and the supranational level of government.

Austria: Tobacco Control

Austria began controlling tobacco in February 1979. The Federal Ministry of Health

and Environmental Protection proposed the first piece of tobacco legislation, which

restricted smoking in hospitals. Health promotion from smoking continued in 1982 with

requirements for on-pack warnings. While the warnings were not applicable to point of

sale materials, three health warnings were to be used in rotation:

“Smoking damages your health”

“Smoking during pregnancy can damage your child’s health”

“Protect your children from tobacco smoke” (Shafey et al, 2003, p. 445).

Also in 1982, the Employees’ Protection Law of 1972 was amended by federal law

requiring employers to ensure that non-smokers were protected from the effects of

tobacco smoke in the workplace. More specifically, the law mandated that when

42

smokers and non-smokers worked together in a single room, smoking was forbidden

unless the non-smokers could be adequately protected by means of proper ventilation. In

1988, the first privately owned airline, Lauda Air, banned smoking during international

flights from Austria to East Asia and Australia (Shafey et al, 2003).

Product regulation began in 1994. The first law regulating tobacco products

limited tar content in cigarettes. The official limit was 15 mg of tar per 1 gram of

tobacco by January 1994, and 12 mg by January 1998, in order to comply with European

Union standards. The year Austria joined the Union, a comprehensive Tobacco Law was

enacted. This law established a minimum age to purchase cigarettes, reinforced current

requirements for health warning labels, and restricted cigarette advertising and sales.

Along with this, it provided that regulations be adopted in the interest of public health –

in order to control the consumption and use of harmful ingredients like additives, aroma,

flavouring, and pesticides in tobacco products (Shafey et al, 2003; Aspect Consortium,

2004).

The Tobacco Law also banned smoking on any premise used for education,

negotiations, and school sporting activities. Though, smoking was not banned on

premises used exclusively for private purposes. Despite this, smoking as restricted in

many public spaces, including public authority buildings and establishments in which

children or teenagers were supervised or provided with accommodations. Smoking

restrictions expanded to include universities and vocational training establishments, as

well as establishments used for performances or exhibitions. While designated smoking

43

areas could be specified, tobacco smoke was not permitted into areas where the smoking

ban applied. More specifically, sufficient numbers of non-smoking areas had to be in

fixed locations in facilities of public and private bus, rail, air, and shipping operations.

Apart from environmental tobacco smoke (ETS) restrictions, the Tobacco Law banned

advertising of tobacco products with more than 10mg of tar (to be effective January

1997) and press advertising was restricted to not more than one advertising page per

periodical, per manufacturer (Shafey et al, 2003; Aspect Consortium, 2004).

The comprehensive Tobacco Law also represented efforts to comply with

supranational directives. For example, policy was enacted which modified on-pack

health warnings, to include: “Smoking increases the risk of cancer” and “Smoking

contributes to heart disease.”

In 1999, Austrian Airlines banned all smoking on all flights. Also in 1999,

supporting legislation was passed restricting smoking further in public indoor places. For

example, smoking was restricted in health facilities, elevators, theatres, cinemas, and

concert halls (Shafey et al, 2003).

More advertising restrictions were also enacted in 1999. Television and radio

advertising of tobacco products was prohibited. Advertising of products in cinemas was

only allowed after six o’clock in the evening. In addition to advertising restrictions in

periodicals, newspaper advertisements were restricted to one page per issue and

specifications were given as to the distance between tobacco-advertisement posters (at

least 150 meters). Tobacco posters were also no longer permitted in the vicinity of

44

schools. In the same year, legislation banned advertising by any means of public

transportation, except international trains, ships, and airways (Shafey et al, 2003).

Product regulation in 1999 consisted of restrictions on the promotion of generic

cigarettes or brands with tar content in excess of 10 mg per 1 gram of tobacco.

Additionally, celebrities, athletes, or young people aged thirty and under were no longer

allowed to be used in tobacco advertising. This restriction was in response to tobacco

companies eluding to the healthy lifestyle benefits of smoking. Finally, requirements

were established requiring ingredient disclosure on cigarette packs (Shafey et al, 2003;

Aspect Consortium, 2004).

Belgium: Tobacco Control

Belgium began controlling tobacco in September 1976. The first law prohibited

smoking in public transportation vehicles, including trams, buses, and underground

trains. However, smoking was not banned. Smokers were instead given designated areas

for consumption. In 1979, legislation was enacted affecting the manufacturing,

marketing, and promotion of tobacco products. More specifically, restrictions were

placed on vending machine distribution, health warning labels were introduced, tar

content was prescribed, ingredients were disclosed on packaging, and advertising and

sales were restricted (Shafey et al, 2003).

In March 1980, free tobacco products (i.e. promotional samples) were prohibited.

The following September, tar and nicotine content were prescribed and health warnings

45

were required on all tobacco products (similar to Austria, four labels were used on an

annual rotating basis). In order to strengthen past legislation, all tobacco packaging,

advertisements, and point of sale materials had to carry tar and nicotine levels of tobacco

products (Shafey et al, 2003).

Further advertising legislation was passed in January 1982, restricting advertising

in the form of bills or posters and required further disclosure of tar and nicotine levels by

manufacturers, for cigarettes. In the same year (December), an official decree was

enacted promoting health education curricula and information programs concerning

tobacco and tobacco use. The same legislation restricted smoking in public places,

health care facilities, and on public transportation (Shafey et al, 2003).

Smoking was also prohibited on premises where school children were present, in

preschools and establishments providing primary, special, and artistic schooling. Finally,

in order to strengthen previous September 1980 legislation, disclosure statements were

required with clear indications of tar and nicotine content on packs of cigarettes, cigars,

cigarillos, and other tobacco products. An additional decree in December 1982 promoted

restrictions against advertising directed at children. In March 1987, legislation was

enacted to reinforce the prohibition of smoking in public places and on premises in

which children or persons of school age were received, cared for, or provided

accommodation (Shafey et al, 2003).

In December of 1990, Belgium passed its first laws regulating tobacco products.

By December 1992, maximum tar yields were to be 15 mg per 1 gram of tobacco and

46

maximum nicotine yields were to be 1.5 mg. By December 1997, amounts were to be 12

mg and 1.2 mg, respectively, in order to comply with EU directives. Along with this,

vending machine distribution of tobacco products was forbidden, unless located in a

tobacco retail shop (Shafey et al, 2003; Aspect Consortium, 2004).

In support of the official decree in December 1982, a law in April 1990

prohibited advertising of tobacco products on radio, television, in newspapers, and other

publications aimed at minors. Advertising was also prohibited using the following

means:

aircraft, boats, or vehicles, except for those taking part in competitions or

being used to transport tobacco;

films, videotapes, slides, other types of visual presentations;

the distribution or door-to-door delivery of stickers or promotional

leaflets;

free samples of tobacco products;

brand names or symbols of tobacco products, or any other image usually

associated with everyday objects, other than those which are part of the

personal equipment of participants in sporting competitions;

and illuminated signs, except within the entrance to places where tobacco

products are available for sale (Shafey et al, 2003).

47

Where advertising is permitted, contents are limited to the name of the product,

brand name and symbol, representations of products directly associated with smoking,

tar and nicotine levels, and information on price and quality.

In May of 1990, additional environmental tobacco smoke (ETS) legislation was

enacted. Smoking was partially restricted in enclosed places where public services are

distributed. This includes places where ill or elderly people are admitted or treated,

healthcare is provided, children or young people are admitted, educational and

professional training are provided, entertainment is offered, exhibitions are mounted, or

sports are practiced. Designated smoking areas are allowed and restrictions are not

applicable to places designed specially for the provision and consumption of food and

drinks, which do not exceed 50 square meters in area. Clearly defined areas can be set

aside for smokers, but they must minimize the nuisance of smoke to non-smokers. In

places where smoking is permitted, a proper ventilation system must be installed, clear

visible signs are to be used, and signs must be displayed with the wording “Beyond this

point, it is forbidden to smoke in the whole building” (Shafey et al, 2003, p.447 )

Following in January of 1992, the executive of the French Community enacted

an order concerning the dissemination of educational campaigns for health by

broadcasting agencies. This was followed by a 1993 order obliging employers to adopt a

policy on smoking at work, to be negotiated with the company’s health and safety

committee (Shafey et al, 2003).

48

In December of 1997, the Crown Order of December 1982 was repealed. This

legislation continued to promote restrictions on tobacco products, specifically

prohibiting advertising at point of sale locations, broadcast media, on billboards, and

sponsorship of sports and other company events. Also the use of names of services or

products indirectly related to tobacco products was prohibited. Finally, the launch of

new products bearing the same name as tobacco products was completely banned

(Shafey et al, 2003).

In September 1999, the Belgian Court amended previous advertising bans so as

to permit tobacco advertising at worldwide events until July 2003. Permission for

indirect advertising was also reinstated (Shafey et al, 2003).

Denmark: Tobacco Control

Denmark did not begin controlling tobacco until 1980. The first law (March

1980) prohibited smoking on premises where food was being prepared for resale. Then,

in June of 1987, the Ministry of Culture prohibited advertising of tobacco on television.

Shortly afterwards, in September 1988, The Ministry of Health banned smoking in all

Ministry of Health workplaces and in meetings of public councils, boards, and

commissions unless all participants agreed to permit smoking. Individual ministers were

directed to introduce non-smoking environments on public premises under their

jurisdiction. However, smoking on government, state-owned premises (i.e.

administrative offices and state-owned hospitals, day care centers, residential institutions

49

and educational establishments) was restricted. Along with this, smoking was prohibited

on public transport with fixed routes (Shafey et al, 2003).

In March 1990, the Ministry of Health began regulating labelling of tobacco

products and tar content. More specifically, all tobacco products were to have the words

“extremely injurious to health” printed on the package, along with tar and nicotine

information (Shafey et al, 2003, p. 459). The Council on Preventive Policy and the

Council on Tobacco-Induced Damage to Health, in May of the same year, passed a law

establishing 1) committees on tobacco control, 2) information programs, and 3)

evaluation of smoking control programs (Shafey et al, 2003).

In June of 1990, the Ministry of Health was authorized to issue provisions to

implement the Directives of the European Union Communities on the labelling of

tobacco products and the tar content of cigarettes and supervise compliance with these

requirements. These provisions included requiring all packs of tobacco products to carry

the general warning, “Extremely harmful to health -- National Board of Health” and also

a specific warning (rotating from previous legislation). Also, tar and nicotine contents

had to be stated on the pack (Shafey et al, 2003, p. 460).

The Ministry of Social Affairs enacted an environmental smoking (ETS) order

protecting public day care centers as well as areas occupied by children, from smoke.

Orders were also enacted by the Ministry of Labor, establishing smoke-free areas for

coffee and lunch breaks in the workplace. In December 1992, previous legislation was

50

reinforced concerning labelling of tobacco products, tar content of cigarettes, and sales

of tobacco products (Shafey et al, 2003).

Then, in December 1992 a code of practice between the tobacco industry and the

government was established. The agreement applied to all tobacco products, including

cigarette paper and tubes. Bans were imposed on all television and radio advertising and

advertising in food outlets and restaurants. Bans were also imposed on the use of

models, actresses or actors appearing to be under 30 years of age, celebrities, health

personnel, and sports personalities. Press advertising was restricted to a single page not

exceeding 2000mm of a single column. Also, advertisements were prohibited from

appearing near articles or pictures related to youth or sports. Health warnings had to

cover ten percent of the total area of the advertisement and all previous restrictions now

applied to indirect advertising ((Shafey et al, 2003; Aspect Consortium, 2004).

In June of 1995, local authorities and every county council were obliged by the

government to establish regulations on smoke-free environments in public sector

workplaces, institutions, and means of transport. In order to reinforce this law, the

Council on Prevention was made responsible for advising national and community

authorities on measures to be taken to promote health and to prevent diseases and

accidents. The law also provided for the appointment, by the Minister of the Interior, on

an independent Council on Tobacco-Induced Damage to Health (Shafey et al, 2003).

In March of 1998, smoking was banned in schools, universities, and on all

domestic flights. Partial restrictions applied to international flights, all intra-Scandinavia

51

and inter-European Union flights (with exception of Spain, Portugal, Greece, Italy, and

Ireland) although smoking on ‘long haul’ was left to the airlines’ discretion (Shafey et al,

2003).

Finland: Tobacco Control

Finland began controlling tobacco in 1976. The first set of laws included

substantial measures to restrict smoking. Over eight percent of estimated annual tax

revenues from tobacco taxes were to be appropriated for tobacco control. Bans on direct

and indirect advertising were promoted, except for foreign printed publications whose

main purpose is not adverting tobacco. Bans were also passed concerning sponsorship

and brand stretching (Shafey et al, 2003).

The sale of tobacco products or accessories to minors under 18 years was

forbidden and signs reading “tobacco may not be sold to persons under the age of 18”

and “tobacco is addictive and damages health” had to be posted where products were

sold (Shafey et al, 2003, p. 463).

Vending machines were only allowed in places licensed to sell alcohol.

Designated smoking areas had to be provided in government buildings (although

employees were allowed to smoke in offices with no clients and where other workers

were not involuntarily exposed to second-hand smoke). Designated smoking areas were

established at private worksites, healthcare facilities, educational facilities, buses, ferries,

52

taxis, railroads, places of entertainment, shopping centers/service centers, and

restaurants. Smoking was also banned in bars and nightclubs (Shafey et al, 2003).

Tobacco manufacturers were required to disclose ingredients to the Ministry of

Social Affairs and Health once a year and health messages and nicotine amounts were

required on all packs. The Council of State was permitted to issue regulations of

substances harmful to health as well as regulate the maximum permissible amount of

additives used in tobacco products. Fines and cease-and-desist orders were set as

penalties for breaking the law (Shafey et al, 2003).

In the following year, licenses were required for vending machines other than in

restaurants licensed to sell alcohol. Oral tobacco was prohibited from being

commercially imported, sold, or otherwise assigned. Nicotine and tar testing methods

were prescribed and health warning labels on tobacco products were reinforced, except

for exports and duty free shops (Shafey et al, 2003).

In February of 1982, the Council of State prescribed the maximum permitted

level of nicotine in tobacco products as 50 mg in 1 g of dry matter of tobacco product. In

this law it is also prescribed that maximum permitted levels of harmful substances be

applied to factory-manufactured cigarettes. Ten years later, the Council also passed a

law regulating tar content to 15mg in cigarettes. Also in 1992, legislation was enacted

requiring health labels on all tobacco products as well as full disclosure of nicotine and

tar levels (Shafey et al, 2003; Aspect Consortium, 2004).

53

In August of 1994, advertising bans were applied to smokeless tobacco. Shortly

afterwards, in March of 1995, children under the age of 18 were prohibited from buying

cigarettes, smoking was banned in the workplace and in public places, including night

clubs, concert halls, theatres, schools, and youth clubs. Then, in 1999, the sale of

tobacco products was prohibited over the internet, unless proper taxing was

implemented. Along with this, the Finnish Tobacco act of 1999 required that restaurants

gradually increase non-smoking areas. Companies were obliged to set aside specially

ventilated smoking rooms, as smoking was banned from all offices with more than one

employee. Smoking was also banned in all public areas, such as stairwells and corridors.

In the same spirit, smoking was banned on all Finnish airlines (Shafey et al, 2003).

France: Tobacco Control

France began controlling tobacco in July of 1976. Initial legislation created a

legal basis for restricting smoking in public places. It also banned advertising on radio,

television, in cinemas, and on all billboards except in tobacco shops. Free distribution of

tobacco and other products bearing tobacco brand logos was forbidden and advertising

in newspapers and magazines was restricted. More specifically, the amount of space

devoted annually to tobacco advertising in the media was not to exceed the average

number of advertising pages published in 1974-1975. Also, advertising was banned in

publications for children. Sponsorship of sporting events was also banned, except for a

limited number of events involving motor vehicles. Finally, smoking was prohibited in

54

schools receiving children under 16, in hospitals, and on public transport (Shafey et al,

2003).

In September of 1977, smoking was prohibited in places intended for use by

groups where the practice may have had "harmful effects upon health." Following this,

legislation was enacted regulating tobacco products. In January of 1978, a list was

established containing substances, which must be indicated on cigarette packages and

the conditions for determining the presence of such substances. In the same year,

tobacconists' shops were banned from opening in hospitals. Also, smoking was restricted

on all aircraft, but not banned. More specifically, effective devices were provided to

prevent the spread of smoke into the non-smoking areas in aircraft (Shafey et al, 2003, p.

464).

In November of 1978, the Law of August 1905 concerning fraudulent practices

and misbranding was applied with regard to products and services related to tobacco,

tobacco products, and tobacco substitutes. A few months later, legislation was also

enacted restricting the space allowed to advertise tobacco in printed press (Shafey et al,

2003).

In June of 1979, the government produced a list of additives permitted in the

manufacture of tobacco and tobacco products and their substitutes. Then, in 1984, a

specific list was passed into law specifying additives (flavouring agents, texture agents,

preservatives, and coloring matter), their permitted levels, and their purity criteria. Three

years later, in 1987, smoking was prohibited in health and educational establishments,

55

food production facilities, premises for young people under 16 years of age, and some

workplaces. The sale of tobacco was prohibited in all health establishments (Shafey et al,

2003).

In January of 1988, information programs were established in order to emphasize

the need to observe provisions of the law attempting to reduce the consumption of

tobacco products in hospitals, in particular. It also stated the specific role of the medical

profession in educating patients on the issue. One year later, vending machines were

banned from being located outside tobacco shops (Shafey et al, 2003).

In 1991, several measures were enacted to combat tobacco use in France. Free

samples were prohibited, smoking was banned in palaces intended for collective and

scholastic use, in collective means of transport, and work places (except in areas

specifically reserved for smokers). Staff of public and private educational institutions

were to be provided with information by the school physician concerning tobacco use.

All cigarettes had to conform to the content restrictions by the end of 1992, with

infractions punishable by fines and brand suspension (Shafey et al, 2003).

Written space for tobacco advertising in newspapers and magazines had to be

reduced by 66%, by 1992, from the average space for such publicity during 1974-1975.

Maximum tar limits and labelling requirements set by the European Union were to be

met. Any advertising, whether direct of indirect, for tobacco or tobacco products, as well

as any form of free distribution, was prohibited. Also, any form of sponsorship was

prohibited if its objective was direct or indirect advertising for tobacco or tobacco

56

products. All point of sale advertising was required to be accompanied by a health

message and the government established the date of an annual event entitled "No

Tobacco Day" This legislation also prohibited using the price of tobacco in calculating

consumer price indexes (Shafey et al, 2003, p. 465; Aspect Consortium, 2004).

In April of 1991, the maximum tar content of cigarettes was implemented by

European Union directive and health warnings were required to accompany any

promotion or advertising for tobacco products. In the same year, methods were

determined for analysing nicotine and tar content and for verifying the accuracy of the

legends to be displayed on packs. In addition to this, systems were established for

printing health warnings and compulsory legends on tobacco packaging of all tobacco

products (Shafey et al, 2003).

In May of 1992, smoking was prohibited in all public places, including

businesses, restaurants, schools, workplaces, and public transport, with areas reserved

for smokers. Smoking was totally prohibited in theatres, exhibition halls, sports arenas,

places where food was prepared or presented for sale, elevators, taxis, aircraft on all

domestic flights of less than two hours operated by national carriers, and dining cars of

trains. Then, in November of 1992, the Evin Law was passed, which banned the direct

and indirect advertising of tobacco products, required posters to carry standard health

warnings, banned smoking of tobacco in all public places (including restaurants, offices,

educational institutions and leisure centers, except in designated areas), buses and Metro

stations in Paris and Lyon. The proportion of smoking areas in trains was reduced to

57

thirty percent -- with smoking banned in restaurant and buffet cars. Individuals who

broke bans risked fines (Shafey et al, 2003).

In March of 1993, smoking was banned in prisons. One year later, additional

sales restrictions were extended to smokeless tobacco. In September of 1995, maximum

additive levels were set and an advisory group on additives in tobacco products was

established. Also, smoking was banned on transatlantic flights and flights within the

European Union on Air France. Finally, in 1992, cigarette tar and nicotine levels were

specifically set to meet European Union standards -- 12 mg of tar and 1.2 mg by

December 1997 (Shafey et al, 2003).

Germany: Tobacco Control

Germany began controlling tobacco in July 1957. Minors under 16 years of age

were not permitted to smoke in public. Then, in 1972, partial restrictions were enacted

on advertising in printed newspapers, magazines, billboards, points of sale, kiosks, and

cinemas. Advertising was also banned on television and radio. Press, outdoor posters,

point of sale promotions, sponsorships, and samples were allowed but subjected to

restrictions. In the same year, advertisements were banned that created the impression

that consumption of tobacco products was 1) harmless to health, 2) likely to have

favorable effects on bodily functions and physical performance, 3) likely to induce

juvenile or adolescents to smoke, 4) make it appear that inhaling of tobacco smoke is

58

something to be imitated, or 5) suggests that tobacco products are natural or pure

(Shafey et al, 2003).

In December of 1975, a list of permitted and prohibited ingredients was updated.

Then, in October of 1991, tobacco products were required to have labels on the

maximum tar content in cigarette smoke. Health warnings, however, were not required

until 1995. In March of 1996, oral smokeless tobacco was banned. Following this, the

High Court enacted a decision, which allowed German companies to ban smoking

completely if most employees agreed with the measure. In this case, however,

companies had to provide acceptable smoking facilities outside the building. Also in

1996, smoking was banned on all domestic flights and on all flights of Lufthansa

airlines. In the same year, cigarette tar and nicotine levels were set to meet European

Union standards of not more than 15 mg of tar and 1.5 mg of nicotine by December

1997 (Shafey et al, 2003).

Greece: Tobacco Control

Greece began controlling tobacco in 1952. The first law prohibited smoking on

trains and buses. In April of 1979, smoking was also prohibited in hospital

establishments and private nursing homes. A smoking room, reserved for hospital

personnel and visitors, was required on every floor of establishments that had an area of

200 square meters or more. In April of 1980, smoking was prohibited in all enclosed

public places belonging to state agencies, public or private companies and organizations,

59

and in other establishments, including post offices, electricity board facilities, hospitals

and private clinics, and cinemas and theatres (Shafey et al, 2003).

In 1987, advertising of tobacco products was banned from radio and television.

One year later, the Minister of Health, Welfare, and Social Security was given power to

regulate the advertising of tobacco products. In December of 1988, health warnings

became mandatory on cigarette packs and cigarette advertisements. In February 1989,

tobacco advertising was prohibited in cinemas (except in films not suited for minors), in

public and private educational institutions, in youth centers, and in sports centers.

Advertisements were also required to carry the warning "The Ministry of Health issues

the following warning: SMOKING SERIOUSLY DAMAGES HEALTH" (Shafey et al,

2003, p. 467).

In March of 1990, smoking was banned on all domestic flights. In the same year,

the European Union directive on tar yields was implemented. In the following year, the

sale of oral moist snuff was banned and smoking was further restricted in buses, planes,

trains, hospitals, and public offices. More specifically, a complete ban was instituted on

smoking in health care facilities, school buildings, government offices, public

transportation, and domestic air transport. Partial restrictions were passed on

international flights (Shafey et al, 2003).

Finally, in 1999, Greece was granted a time extension to meet the tar and

nicotine standards set by the European Union. They were required to come into

compliance with 15 mg of tar and 1.5 mg of nicotine by December 2000, and 12 mg of

60

tar and 1.2 mg of nicotine by December 2008 (Shafey et al, 2003; Aspect Consortium,

2004).

Italy: Tobacco Control

Italy began controlling tobacco in 1962. The first law prohibited all advertising

of tobacco products, irrespective of the medium employed. Bans included point of sale,

sampling, sponsorship, television, radio, cinema, press, and outdoor advertising. Limited

trade advertising was permitted by the Federazione Italiana Tabaccai (FIT) (Shafey et al,

2003).

In November 1975, smoking was banned in hospitals, school classrooms, closed

premises used for public meetings, cinemas and theatres, dance halls, betting shops,

academic lecture halls, libraries, reading rooms open to the public, and private and

public art galleries. Fines were set for owners or managers of the premises not respecting

the law. Smoking was also severely restricted on public transport with a ban on smoking

in buses. In May 1976, an exception was made to the smoking ban for premises in which

an air conditioner or ventilation system, meeting prescribed conditions, was installed

(Shafey et al, 2003).

In February 1983, fines were raised for breaking advertising prohibitions laid

down in April 1962. Six years later, health warnings were required to be displayed on

tobacco products and the promotion of products or services named after tobacco goods

was also banned. In July 1990, Italy implemented the European Union directive on

61

maximum tar yields. One year later, the government also implemented the European

Union directive on labelling -- health warnings and ingredient disclosure. Also in 1991,

direct and indirect advertising of tobacco products on television was prohibited (Shafey

et al, 2003).

In December 1995, smoking was prohibited in all premises used, for whatever

purpose, by the public administration and public bodies in carrying out their institutional

functions, as well as by persons in the private sector providing public services. Premises

subject to such prohibition were to display a notice to this effect, indicating the

regulation in question, the sanctions incurred, and the authorities empowered to assure

compliance with the prohibition and record infringements (Shafey et al, 2003).

In the same year, it was made illegal to sell or give tobacco products to children

under the age of sixteen. Along with this, smoking was prohibited on all domestic

flights, as well as eighty percent of flights between the U.S. and the European Union on

Aitalia airlines (Shafey et al, 2003).

Finally, in 1995, cigarette vending machines were only allowed to be installed in

the immediate surroundings of the relevant retailer. They could not be installed in

buildings linked to the supervision of the arts and all advertising on cigarette vending

machines was prohibited (Shafey et al, 2003).

62

The Netherlands: Tobacco Control

Tobacco control began in the Netherlands in 1981. The first law established that

smoking was a threat to health. More specifically, the words “Minister of Health and

Environmental Protection” and nicotine and tar contents were required to appear on

cigarette packs. In December 1986, tar and nicotine contents were required to be shown

on cigarette packaging with official health warnings on both the front and backs of

packs. A system of four rotational health warnings was put into operation and tar and

nicotine levels were required to be determined in accordance with a method designated

by the ministers of a) Welfare, Health, and Culture Affairs, b) Agriculture and Fisheries

Agency, and c) Department of Economic Affairs (Shafey et al, 2003).

Shortly afterward, the Tobacco Law of 1988 was enacted requiring ingredient

disclosure by manufactures and prohibiting the sale and use of tobacco products in

health care facilities, social welfare offices, sports arenas, and socio-cultural and

educational establishments administered by the State. Furthermore, advertising of

tobacco products was forbidden on radio and television. Finally, oral tobacco was

prohibited (Shafey et al, 2003).

In December 1989, smoking was banned in some areas of buildings belonging to

or run by the state, including all places to which the public had access and all communal

areas (except offices), specifically rooms containing counters, waiting rooms, halls,

corridors, stairways, elevators, meeting rooms, classrooms, toilets, canteens, and rest and

leisure rooms. However, smoking bans could be suspended in waiting rooms, canteens

63

and leisure rooms where permission may be given to smoke either on a third of the

surface area or for a period limited to one-third of operating hours, if this does not bother

non-smokers (Shafey et al, 2003).

In 1992, restrictions were enacted on smoking in workplaces, public places,

schools, health care facilities, and government buildings. Penalties were also set for

breaking the decree. In August 1998, all smoking was banned on all flights of KLM

Royal Dutch Airlines and the sale of tobacco products to individuals under 18 years of

age was prohibited (Shafey et al, 2003).

One year later a code was established between the tobacco industry and

publishers. Advertising was not to be aimed at young people or non-smokers. A

relationship between health, sports, youth, and tobacco was not allowed to be suggested

in advertisements. No advertising was allowed in testimonials, billboards, aircraft, trains,

buses, or hospitals. No collective campaigns for tobacco products were allowed and

health warnings were required to be in all advertisements. Portraying people below 30

years of age or advertising in media with more than 25% young readers was prohibited

(Shafey et al, 2003).

Finally, no advertising was allowed in nightclubs, at festivals or in movie

theaters. Free samples were prohibited to people below 18 years of age and no sports

sponsorship (except motor and car racing) was allowed. Direct mail or un-addressed

mail actions (without prior consent) were prohibited (Shafey et al, 2003).

64

Portugal: Tobacco Control

Tobacco control began in Portugal in 1978. Smoking was prohibited in urban

public transport as well as in inter-urban public transport on journeys lasting up to one

hour. In September 1980, general principles for smoking control were set out, including

an adverting prohibition, smoking prohibition, requirements for health warnings and

ingredient disclosure, maximum nicotine and tar contents, and penalties. As of 1984, all

tobacco advertising, with the exception of limited point of sale activities, was prohibited

(Shafey et al, 2003).

In May 1983, evaluation standards were established for smoking control

programs and smoking was prohibited on the premises of health care facilities, in

teaching establishments, and on premises intended for persons aged less than 16 years of

age. Also, advertising for tobacco in national media outlets was prohibited. Health

warnings were required for all cigarettes intended for inland consumption with an

indication of the nicotine and tar content on the pack (Shafey et al, 2003).

In the same year, tobacco advertising on television, radio, in newspapers,

magazines, coupons, cinemas, billboards, and at points of sale was prohibited. Health

warnings were also required for remaining advertising. Smoking was prohibited in all

places where health care was dispensed, all premises used by minors under 16 years of

age, educational establishments, enclosed sports facilities, theaters and other enclosed

premises for entertainment and leisure activities, and public waiting rooms and elevators

(Shafey et al, 2003).

65

Specific smoking areas could be provided on the condition they were not used

by sick people, minors, women who were pregnant or breast feeding, or participants in

sporting events. In addition to this, smoking was banned in libraries, restaurants (at

owner's initiative) and workplaces (at non-smokers' initiative if there are areas where

smoking can be permitted). Smoking was also banned in the Parliament assembly halls

and meeting rooms. Finally, fines were established for individuals and organizations

breaking these laws (Shafey et al, 2003).

In 1991, Portugal implemented the European Union directive on maximum tar

content and labeling. In the same year, a decree was enacted which allowed tobacco

sponsorship of motor sports vehicles competing in organized events which were part of

the European Union or World championship. In addition to this, committees on tobacco

control were established and bans were instituted against the sale and consumption of

oral smokeless tobacco (Shafey et al, 2003; World Health Organization, 1997).

In 1996, free tobacco samples were forbidden, vending machine distribution was

banned, and smoking was banned on all flights of TAP Air Portugal airlines. Finally, in

the same year, the minimum age for purchase and consumption of tobacco was

established as 18 (Shafey et al, 2003).

Spain: Tobacco Control

Tobacco control began in Spain in 1978. The first Crown Decree focused

attention on regulating advertising for tobacco and alcoholic beverages by state

66

broadcasting media. In April 1979, the expression 'low nicotine' was allowed to be used

in connection with the marketing and advertising of cigarettes; only if nicotine yields of

one cigarette were less than 1 mg. The expression 'low tar' could only be used if tar

yields of one cigarette were less than 16 mg of tar. Under this decree, samples of all

cigarette products were to be submitted to government authorities for standards testing.

Furthermore, in May 1980, low tar and low nicotine cigarettes were only allowed to be

advertised as such when authorized by the government (Shafey et al, 2003).

In 1982, smoking was banned in health care facilities and on public

transportation. Information advertising of new tobacco products with low tar and

nicotine contents were permitted for two years following their introduction to the

market. All advertising of tobacco products was banned through public information

channels (television and radio). Health warnings were required on all packs of tobacco

for sale on the domestic market and sales of tobacco to those under 16 years of age was

forbidden. New tobacco products with more then 24 mg of tar and 1.8 mg of nicotine

were banned from introduction into the market (Shafey et al, 2003).

In July 1984, the rights of non-smokers were formally recognized under Spanish

law, which stated that the right to health of the non-smoker always precedes the right of

smokers to smoke. In the same decree, smoking was banned (except in designated areas)

in welfare establishments for children under 16, health centers, educational

establishments, public administration premises to which the public has direct access,

premises where food is prepared, exhibition halls, reading rooms, enclosed commercial

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premises, theaters, cinemas, sporting halls, elevators, urban and long distance vehicles

and means of collective transportation admitting standing passengers, school buses,

medical transportation, domestic flights less than 90 minutes, and workplaces with

industrial contaminants or pregnant women (Shafey et al, 2003).

In March 1988, rotating health warnings and the display of tar and nicotine

contents on cigarette packs was required. The maximum tar yield for one cigarette was

established at 15 mg and the maximum nicotine yield was 1.3 mg. Cigarettes classified

as low nicotine, low tar, as well as those with light or mild designations were required to

meet specific standards. Smoking was not permitted in welfare centers for youth, health

centers, teaching centers, halls for use by the general public, all urban and long-distance

vehicles for collective transport, school vehicles, rail and sea transport, and in any place

where a greater risk to the health of workers exists through the combination of the harm

caused by tobacco and industrial contamination (Shafey et al, 2003).

Posters reminding the public of the ban on sales to children were required to be

placed in tobacco shops. The sale of tobacco products was forbidden in health

establishments, educational establishments, and those intended for care of children.

Products were allowed to be sold from automatic vending machines only on enclosed

preemies and machines were required to display health warnings (Shafey et al, 2003).

In June 1988, signs and warnings to designate non-smoking areas were required

to be visible and intelligible in design and format. Nicotine and tar contents were

required to be stated on packs of cigarettes marketed in Spain. In the same year, tobacco

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advertising on television was restricted to the hours of 2200 and 0800. Press and

billboard advertising was limited and free distribution of cigarettes was prohibited

(Shafey et al, 2003).

Similarly, in 1995, tobacco manufacturers agreed not to advertise in theaters or

on billboards, as well as bus shelters that were situated less than 200 meters away from

schools or colleges (Shafey et al, 2003).

Finally, in 1998, all advertising of tobacco products was banned from television,

video, audio tapes sold or rented to the public, publications whose purpose is primarily

addressed to minors under the age of 18, cinemas showing films intended expressly for

and attended mainly by young people aged under 18 years of age, posters, billboards,

and other large public display media located within less than 200 meters from the

entrances to schools and other educational centers (Shafey et al, 2003; World Health

Organization, 1997).

Product promotion and promotional articles were not allowed to be addressed

persons under the age of 18 and printed communication matter regarding tobacco

products was required to display health warnings, as well as nicotine and tar content.

Finally, Iberia and Spanair ban smoking on all North Atlantic, Intra-European Union and

Intra-Spain flights. The only flights where smoking would be allowed were between

Spain and Buenos Aires, Rio de Janeiro, and Sao Paulo and between Spain and Cuba.

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Sweden: Tobacco Control

Tobacco control began in Sweden in 1975. The first set of laws focused on

warnings and declarations of harmful content to be displayed on tobacco products. In

May 1976, the National Board of Health and Welfare required all tobacco products to

display health warnings and ingredients. Following in 1978, The National Board of

Consumer Policies prohibited advertising of tobacco products in the sports pages of

daily newspapers, in sports newspapers, and in publications aimed at people under 20

years of age. At this time, distribution of free samples was prohibited (Shafey et al,

2003).

Then, in 1982, the National Board of Health and Welfare amended the 1976

policy by requiring the levels of harmful substances in cigarette smoke and the year to

which they are applicable, on cigarette packs. Also the permitted discrepancy between

declared levels and actual levels found in products was raised to fifteen percent (Shafey

et al, 2003).

One year later, smoking was restricted in the workplace and other public places.

In 1986, smoking was banned on all domestic flights of Linjeflyg airlines. In 1988, a

general law was passed stating that no one should, against his will, be subjected to

discomfort or to health hazards caused by tobacco smoke in public places and

workplaces. In 1993, the sale and advertising of tobacco products was restricted. In the

following year, smoking was banned in schools, health care facilities, and on public

transportation. Bans were also instituted on advertising of tobacco products (except in

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tobacco shops). More specifically, only trade magazines were allowed to carry tobacco

advertisements and even they were restricted in content (Shafey et al, 2003).

Within this legislation, employers were given the responsibility for ensuring that

employees are not exposed to smoke at work. Similarly, restaurants seating more than 50

people were required to have a non-smoking area. Then, in 1994, the Tobacco Law was

passed. This law prescribed maximum levels for harmful substances that a tobacco

product contains. Cigarette packs were required to show one of 16 messages issued by

the National Board of Health and Welfare. Packs were to display a declaration of

content, as well as the corresponding average for all brands sold in Sweden (Shafey et al,

2003).

In addition, smoking was prohibited on premises intended for activities for

children and young people, for medical and health care, for joint use in residential

accommodation and special service or care, on domestic public transport or in areas

intended for use by passengers, in premises where a public meeting or event is being

held and in other premises if the general public has access. Non-smoking rooms were

required to be provided in hotels, transport, and restaurants with more than 50 seats. All

radio and television advertising was banned and other forms of advertising were to be

used in moderation. Tobacco manufacturers were not allowed to actively seek new areas

of trade or encourage tobacco use (Shafey et al, 2003).

Finally, beginning in 1998, the maximum permitted tar level was lowered to 12

mg per cigarette to comply with European Union standards and maximum nicotine

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content was lowered to 1.3 mg per cigarette, as specified in 1993 (Shafey et al, 2003;

Aspect Consortium, 2004).

United Kingdom: Tobacco Control

Tobacco control began in the UK in 1964. The first set of laws focused on

banning advertising for cigarettes and roll-your-own tobacco on television and radio

outlets. Then in 1978 and 1979, legislation was enacted to regulate financial matters

concerning tobacco revenue and establish standards for higher tar cigarettes,

respectively. In 1986, the sale of oral tobacco was prohibited and it was made an offense

to sell tobacco products to persons under the age of 16, including vending machine sales.

As such, owners of vending machines were required to prevent the machine from being

used by those under 16 years of age (Shafey et al, 2003).

In 1986, a voluntary agreement on advertising, promotion and health warnings

was passed. This agreement ended cinema advertising, limited poster advertising to half

of the level of the previous year, prevented posters from being positioned close to

schools, and prohibited advertising in magazines where one third or more of reader are

young women. Also, an independently chaired Committee for Monitoring Agreements

on Tobacco Advertising and Sponsorship (COMITAS) was established. Finally, this

agreement provided for the addition of six rotating health warning on all packs and

advertisements (Shafey et al, 2003).

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In 1988, smoking was banned on all domestic flights and the sale of oral snuff

was prohibited. In 1991, the Children and Young Persons Protection from Tobacco Act

increased penalties for selling to minors. Additionally, local authorities where cited with

the responsibility for implementing the law. This set of laws also required retailers and

vending machine operators to display warning notices stating that “it is illegal to sell

tobacco products to anyone under the age of 16” (Shafey et al, 2003, p.503).

Similarly, in 1992, the government required that health warnings be displayed on

tobacco products and that advertising be restricted further. These restrictions were

purposely designed to be more strict than those mandated by the European Union. For

example, limits were placed on advertising on videos for private use as well as with

magazines with 25% young female readership. The number of external advertising signs

was required to be reduced by 50%, phased over five years (Shafey et al, 2003).

In the same year, the government enacted product regulations -- setting the

maximum tar limit in a cigarette at 15 mg. Along with this, the Consumer Protection Act

of 1992 required specifically that tobacco products be labeled clearly with health

warnings and ingredient disclosures on the pack (Shafey et al, 2003; Aspect Consortium,

2004).

In June 1995, shop-front advertising of tobacco products was prohibited, along

with advertising on posters under 48”sheet size (mobile size). In addition, limits were

placed on expenditures on poster advertisements and government health warnings were

required to appear on all such advertisements. Tobacco advertising was also banned on

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computer games and in any place within a 200 meter radius of school entrances (Shafey

et al, 2003).

In 1999, smoking was banned on all flights of British Airways, British Midland

airlines, and Virgin Atlantic airlines. In the same year, smoking was restricted in

workplaces, public places, schools, health care facilities, public transportation, and in

government buildings (Shafey et al, 2003).

Framework for European Tobacco Control Policy Explanations

Country-level policy descriptions make clear the wide variation of instruments

used to control tobacco, especially cigarette consumption. These non-price policies come

in addition to fiscal policies designed to make cigarette consumption more expensive by

raising cost through different taxation strategies. In order to link policies to specific

outcomes, it is beneficial to consider the causal theory about how general policy goals

are obtained (Meier and Licari 1998). Policies controlling tobacco are aimed at

manipulating either the supply or demand of tobacco products available to consumers.

Manipulating demand for tobacco via government intervention is difficult, however,

given the addictive nature of tobacco products, especially cigarettes. The ability of target

populations (e.g., manufactured-cigarette smokers) to respond to these regulatory efforts

is constrained by relative levels of addiction to the commodity. This phenomenon in the

tobacco politics literature is well documented. For example, Licari (1997, 2000) and

Meier and Licari (1998) develop a formal model of cigarette consumption which

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accounts for three levels of possible addiction, or demand elasticities. Addicts

theoretically have inelastic demand for cigarettes. Increasing the price of cigarettes does

not compel addicts to decrease demand. Conversely, quitters have highly elastic demand

curves which are sensitive to most efforts aimed at deterring consumption. In this

situation, price increases of any size provide compelling reason to quit smoking.

Between addicts and quitters are those with normal demand elasticities. Their demand

curves are theoretically only slightly more inelastic than quitters (i.e., closer to the

demand elasticity associated with a non-addictive commodity or good). Aggregate

consumer demand represents all three types of consumers: addicts, quitters, and those in

between.

Traditional price policies may thin aggregate demand by altering the target

population to include those less likely to quit. Non-price tobacco control policies are

also aimed at shifting aggregate demand towards less consumption, by conveying further

costs, or disincentives. Table 1 summarizes the main non-price policy instruments,

drawn from above tobacco legislation descriptives. Specific examples of implementation

strategies associated with each instrument are also reported.

The first step in making use of the instrumental approach is to group policy

instruments according to dominant underlying attributes. For example, while warning

labels and educational campaigns represent different avenues to tobacco control, as

policy instruments they share attributes of providing consumers with information,

allowing them to decide for themselves whether and how much risk is acceptable

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TABLE 1 Summary of European Policy Instruments to Control Tobacco, 1970- 2000

Policy Instrument Implementation Examples Advertising Partial restrictions or bans on cigarette ads across newspapers, magazines, radio billboards, points-of-sale, and television. Regulation of advertising content and sponsorship. Limitations on advertising where minors are present, including schools and movie theaters.

Ban on free samples of tobacco. Sales Minors6 banned from purchasing tobacco in shops or vending machines.

Tobacco sales not permitted in proximity to

schools, premises where minors are likely present, or healthcare facilities.

Ban on selling tobacco products through

vending machines. Environmental Tobacco Smoke Restriction on smoking in public spaces, in (ETS) proximity to childcare facilities, hospitals, outdoor arenas, and international and domestic flights. Workplace protection of non-smokers. Designated smoking rooms required. Establish standards for dual-ventilation systems.

6 Most member states designate those under 18 as ‘minors’, concerning the purchase of tobacco products (exceptions include Spain and Italy where a minor is designated under 16).

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TABLE 1 Continued.

Policy Instrument Implementation Examples

Ingredients Establish list of permitted and prohibited ingredients allowed in tobacco products. Standards established for ingredients of cigarettes classified as low nicotine and tar, light, or mild.

Health Warnings Warning labels required on cigarette packs, tobacco advertisements, and points-of-sale. Strong warning labels required linking smoking to death and disease, sanctioned by government health official. Rotation requirement for warnings on cigarette packs. Capacity-Building Grants of authority to agencies or councils to monitor industry compliance to government regulations. Establishing protocol for monitoring established ingredient standards. Educational Campaigns Development of public information programs regarding tobacco use. Adoption of health education curriculum which includes dangers of smoking initiation and benefits of smoking cessation. Information on tobacco use made available to staff of public educational institutions by school physicians. Establish national advisory board for deciding and disseminating information on tobacco consumption. Source: Shafey et al, 2003

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(information). The remaining instruments (sales, ETS, ingredients, capacity-building,

advertising) share attributes of setting standards for what is permitted, and for building

control mechanisms to ensure compliance (command – control) in the regulation of

tobacco.7

The second step is to determine empirically whether these policy instruments

converge on common underlying notions.

TABLE 2 Principal Component Factor Analysis of Tobacco Control Policy in European Union Countries: 1970-2000.8

Policy Factor Loadings Policy Factor Loadings Command-Control: Information:

Advertising .788 Health Warnings .755

Sales .839 Educational Campaigns .755

ETS .804

Ingredients .875

Capacity-Building .914

Retained Factors 1 Retained Factors 1 Eigenvalue, Factor 1 3.57 Eigenvalue, Factor 1 1.13 N 420 N 420 Cronbach’s α .886 Cronbach’s α .272 Principal-component analysis conducted with STATA 9.0.

7 Additional discussion of command-control and informational policy instruments is offered in Chapter IV. 8 Fourteen EU countries are included in all factor analyses reported in this chapter: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Portugal, Spain, Sweden, Netherlands and the United Kingdom. Luxembourg is not included due to data limitations.

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Principal component analysis is appropriate for this purpose. I explore two strategies.

First, I apply principal component analysis based on the theoretical distinction between

command-control and information policies coming from the regulatory policy literature.

Command-control policies, for example, are correlated. A factor analysis (Table 2) of

instruments aimed at restricting tobacco advertising, sales, environmental tobacco

smoke, cigarette ingredients, and provisions for capacity-building and accountability

indicates that a single factor accounts for over 70 percent of variation with each factor

loading at .78 or higher.

Similarly, a factor analysis of information policies which provide health

warnings and authorize educational campaigns indicates that a single factor accounts for

over 56 percent of variation with each factor loading .75 or higher. The scale reliability

coefficient among information instruments, however, calls into question whether this is

the most appropriate way to categorize these policies.

The second strategy assumes no theoretical distinction among policies in the area

of tobacco control in Europe. I am interested in whether the collective behavioral

attributes of non-price policies represent another succinct way to determine how policies

and outcomes are connected. Instead of running two separate factor analyses, I perform

one factor analysis of all policies using two rotations: unrotated factors and oblique-

rotated factors. Table 3 reports findings from the unrotated analysis. Of the four factors

retained, a single factor accounts for 88 percent of variation with each factor loading at

.75 or higher. This provides one possible measure of policy scope that may be useful in

further empirical analysis.

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TABLE 3 Unrotated Factor Analysis of Tobacco Control Policy in European Union Countries: 1970-2000. Policy Factor Loadings Advertising .778 Sales .750 ETS .766 Ingredients .841 Capacity-Building .915 Health Warnings .804 Educational Campaigns .630 Retained Factors 4 Eigenvalue, Factor 1 4.27 N 420 Cronbach’s α .893 Principal-component analysis conducted with STATA 9.0.

Table 4 reports findings from the oblique analysis. Oblique rotation is an improved

method of analysis over un-rotation in this context because oblique rotation assumes

items included in the analysis are correlated.9 A single factor accounts for over 65

percent of the variation with each factor loading .63 or higher. Factor scores from Table

4 are used as a measure of policy scope in Chapter IV and Chapter V. I choose these

over

9 Correlation is assumed in the case of European tobacco control because many of these policy interventions are adopted simultaneously across countries and they cannot be thoroughly disentangled with available data. Despite not having ideal data, I am able to continue advancing a test of an instrumental theory of public policy by considering a measure of policy scope. I will compare this measure to those developed in Table 2 in Chapter III.

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TABLE 4 Principal Component Factor Analysis with Oblique Rotation: Tobacco Control Policy in European Union Countries: 1970-2000. Policy Factor Loadings Advertising .813 Sales .774 ETS .803 Ingredients .852 Capacity-Building .919 Health Warnings .828 Educational Campaigns .630 Retained Factors 1 Eigenvalue, Factor 1 4.56 N 420 Cronbach’s α .893 Principal-component analysis conducted with STATA 9.0.

Table 3 based on the assumption of correlation advanced by oblique rotation within

principal component analysis (Nunally and Berstein, 1994).

In conclusion, there are seven main non-price policy instruments which have the

purpose of influencing cigarette demand: restrictions on environmental tobacco smoke,

sales, advertising and promotion, product health warnings, product control through

ingredients, capacity building for regulatory compliance, and educational campaigns on

dangers of tobacco consumption. These policy instruments can be analyzed two ways:

First, they can be presented as theoretically distinct according to whether they converge

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on common notions of information and command-control. While this is the preferred

strategy for testing the theory presented in Chapter II, modifications may have to

accommodate the realities of policy adoption in this context and data limitations.

Secondly, data reduction strategies can be used to account for simultaneous adoption and

correlation, which produce a measure for overall policy scope. I test an instrumental

theory of public policy using and comparing both strategies in the next two chapters as I

explore further the effectiveness of policy instruments in curbing consumption.

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CHAPTER IV

TOBACCO CONTROL AND HEALTH GOVERNANCE

Chapter III illustrates which tobacco control instruments are employed across

Europe at the member state level using historical analysis. Additionally, Chapter III

organizes tobacco control efforts into policy instrument categories and discusses how

they are related to policy outcomes by way of economic theories of supply and demand,

given various demand elasticities. Chapter IV incorporates information from previous

chapters to conduct an empirical analysis of determinants of tobacco consumption across

the European Union from 1970-2000. This chapter, along with Chapter V gives a more

complete picture of tobacco policy effectiveness by exploring individual and multiple

interventions, along with overall policy scope and supranational considerations for

policy performance.

First I discuss how tobacco policy interventions can be understood as

mechanisms of governance to improve European public health. Secondly, I introduce a

model of policy effectiveness which considers the independent influence of price and

non-price policy instruments, as well as their combined influence on consumption. I

develop policy measures consistent with the instrumental view presented in Chapter I,

while also taking into account the influence of the policy environment. Finally, I present

findings and implications for European tobacco control specifically, and the study of

comparative public policy, generally.

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Tobacco Policy Interventions as Mechanisms of Governance

Assessing how public policies govern public health begins with the argument that

policy instruments are governance mechanisms. Policy is one expression of the

relationship between states and societies in a modern system of governance. For

example, policies may reflect how governments respond to balancing rights of

individuals with broader notions of public protection when the greater public health is at

risk.

The response of health outcomes to various public policies depends in part on

which instruments are used and how amenable the policy environment is to creating a

context of support. In this section, I establish how a logic of governance is useful for

evaluating and comparing policy outcomes. These ideas shape the empirical model of

policy effectiveness of tobacco control in the multilevel environment of the European

Union.

The first portion of the chapter introduces the concept of governance and how it

applies to multilevel settings of policymaking. Secondly, I link policy instruments as

governance mechanisms to overall policy performance by developing a model for

tobacco policy effectiveness. Thirdly, I develop and empirically test several hypotheses

related to propositions in Chapter II. Finally, I discuss the implications for an

instrumental theory of public policy and introduce how certain features of the multilevel

context of European Union may influence effective national strategies for controlling

tobacco.

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Governance

The scholarly use of the term ‘governance’ has evolved over the last half century.

However, the most consistent characterization of the concept is its functional capability,

or its mechanisms. Governance represents the combined functions of state and non-state

actors and policies in affecting target populations in pursuit of policy goals (Kjær, 2004).

In organization theory, governance is the combined contribution of management,

the environment, structure, clientele characteristics and core processes in pursuit of

organizational success (Lynn et al. 2001). A similar notion of governance is applied in

bureaucratic agencies, but with more attention give to political actors, values and

institutions in the environment. For example, bureaucratic values such as accountability,

efficiency and equity are held by individuals and organizations. These values can be

mechanisms for shaping how agencies go about their work and can guide how successful

agencies are at performing core tasks (Meier, 1993).

In the political sphere, political property rights and transaction cost politics are

mechanisms of governance used by rational political actors when operating within the

constraints of irrational political organizations. Similarly, contracts and the market

represent mechanisms of governance in the economic study of organizational life

(Williamson, 1996). Agreements made the during contracting period, for example, guide

the behavior of organizations, agencies and individuals in their search of optimal

performance (Llewellyn, 1931; Alchian and Demsetz, 1972; Macneil, 1974; Jensen and

Meckling, 1976). A number of governance mechanisms are used to manage transaction-

cost politics. For example, agency design, rulemaking procedures and structures for

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controlling the bureaucracy represents factors which can affect policy implementation

and performance (McCubbins et al, 1987, 1989; Moe, 1990; Meier and Waterman,

1997; Wood and Bohte, 2004).

These examples point to the proliferation of governance mechanisms, especially

those which are likely to affect policymaking and outcomes.

Governance Mechanisms, Multilevel Systems and Policy Outcomes

Policy outcomes can be a function of national and supranational governance

strategies in the European Union. First, policy instruments can come exclusively from

national or supranational levels of government or they can be the result of combined

efforts. In the case of tobacco control, every European country had adopted exclusive

national policies towards tobacco before supranational directives were instituted (Shafey

et al, 2003). A comprehensive evaluation of tobacco control in Europe must provide a

way to account for the impact of governance strategies from multiple levels of

government.

The policy instrument framework introduced in Chapter II provides a way for

thinking about how these different policy efforts contribute to outcomes. It is important

to know how policy instruments function in order to build proper models of policy

implementation. Even if a policy is implemented properly it still may fail if the

instrument is inappropriate (Meier and Licari 1998). Therefore, before turning to

complex implementation theories, it is useful to find out how much of the policy effects

can be explained simply by instrument performance.

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Lowi’s (1964) work was among the first to target policy tools as significant

political phenomena. In fact, his four-fold classification of policy types (distributive,

redistributive, regulatory, and constituent) provides a framework for understanding

dynamic political consequences of varying policies. However, in order to further

evaluate the richness and complexity of certain polices, it is essential to move beyond

general policy typology frameworks and begin investigating how multiple instruments

achieve particular policy goals (Schneider and Ingram, 1990). Whether national or

supranational, tobacco control policies and directives have behavioral attributes.

Concern over policy instrument effectiveness in politics is consistent with that in

several disciplinary arenas. For example, economists evaluate levels of economic

stimulus or constraint based on the utilization of fiscal or monetary policy instruments

(Woolley, 1988; Ott and Ott, 1968). Business management scholars investigate role of

patent protection and product standards in explaining research and development funding

and industry success or failure (Joglekar and Hamburg, 1983). Demographic specialists

focus on the influence of population policy instruments in achieving desired fertility and

social development (Pritchett, 1994; Carmen and Potter, 1980).

In political science the discussion of policy instruments has been “incidental

rather than a matter of central concern” (Schneider and Ingram, 1990, p. 512). This

deficiency has motivated scholars to refocus attention on the comparative effectiveness

of different individual instruments (McDonnell, 1988; Gormley, 1987; Salmon, 1981).

The result has been the development of different policy instrument classification

systems. The most common is Schneider and Ingram’s (1990;1997) fivefold

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differentiation of: 1) authority, 2) sanctions and inducements, 3) capacity building, 4)

exhortation and 5) learning. These categories were constructed by Schneider and Ingram

upon analyzing the work of Bardach (1979), Almeria (1987), Gormley (1987) and

McDonnell (1988) who suggest policy instruments can be labeled a number of ways,

including as prescriptive, enabling, coercive, catalytic, hortatory, mandatory,

inducements, and system changing.

The ideal method for testing an instrumental theory of public policy is to capture

the attributes of each policy instrument (both national and supranational) in a dataset and

determine their unique influence on policy outcomes. Unfortunately, the complexities of

policy adoption are such that taking that strategy results in a high potential for

collinearity due to simultaneous adoption of policy instruments over time and across

member states. Therefore, two approaches are taken to produce evidence testing an

instrumental theory of public policy. First, I develop a model using a measure of policy

which distinguishes among information and command-control instruments. I also

explore how price policies work in combination with these instruments. Secondly, I

develop a model using a policy-bundle approach where I create a single measure of non-

price policies (policy scope) and combine it with price policies. I discuss implications

for using a more aggregate measure of non-price policies on understanding an

instrumental approach to policy effectiveness.

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Tobacco Control and Policy Instrument Effectiveness

Tobacco control is a fertile policy environment in which to study the relative

effectiveness of individual and multiple policies. First, tobacco is everywhere. It is

consumed and controlled in every member state and at the supranational level.

Therefore, variations in policies and outcomes at all levels provide leverage on

addressing the following general research question: how are health policy outcomes

governed by policy instruments in a multilevel system of policymaking?

Secondly, this policy area provides the opportunity for investigating the

effectiveness of price and non-price policy instruments targeting one variegated

population. Finally, this policy context allows me to identify instances where policies are

working, and under what circumstances.

Developing a Model for Tobacco Policy Effectiveness

There is a growing concern over population health governance as over half a

million people within the European Union die each year due to tobacco-related illnesses

and diseases, especially those associated with cigarette smoking (Aspect Consortium

2004). The tobacco epidemic has caught the attention of policymakers at all levels of

government. They seek ways to mitigate rising negative health consequences associated

with consumption, morbidity and mortality (Aspect Consortium, 2004).

Policymakers often intervene in the marketplace when public health is at risk. In

fact, they often try to mediate adverse health effects by choosing command and control

policies to regulate food and drug products, medical procedures, alcohol, and tobacco.

89

Aside from Meier and Licari (1998) and Licari (2000), limited empirical work has

focused on evaluating the effectiveness of multiple policy instruments in the area of

tobacco and health. Although largely descriptive, Studlar (2002) has explored the

transfer of policy instruments used for tobacco control in the United States and Canada.

Studlar contends that tobacco-control policy research focuses on five main policy

instruments: regulation (command and control), finance, capacity building, education,

and learning tools. Each instrument includes sub-areas of interest.

Regulatory tools target tobacco advertising, sales, environmental smoke, and

product ingredients. Financial policy tools propose taxes or levies on tobacco products,

manipulate agricultural incentives, promote litigation against tobacco manufacturers, and

address the incentives for smuggling (Studlar, 2002; Pal and Weaver, 2002). Capacity

building refers to funding for community development of programs to combat tobacco

use, establishing health councils to monitor tobacco industry activities, and grant

authority to agencies or councils to monitor industry compliance. Education and learning

tools include health warning labels, general anti-smoking campaigns, development of

public health curricula, and can subsume legislative hearings and executive reposts

related to tobacco control.

These categories capture mostly non-price policy efforts. Licari (2000) and Meier

and Licari (1998) make a case for the importance of studying both non-price and price

policies when developing empirical models of tobacco control.

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Cigarette Price-Policy

The most common regulatory device for controlling tobacco is through taxation.

Taxes on cigarettes work causally by affecting the price of cigarettes (Chaloupka and

Warner, 1999; Licari 2000). Tobacco taxation varies a great deal across Europe. Figure 4

demonstrates the variation in average price of cigarettes across Europe, 1970-1980.

FIGURE 4 Mean Cigarette Price per Pack (US Cents): 1970-1980

0 100 200 300mean of price

SpainNetherlands

FranceBelgiumGreece

PortugalAustria

GermanyItaly

FinlandIreland

SwedenUnited Kingdom

Denmark

Mean Cigarette Price

Source: OECD National Accounts (2006).

During this decade Denmark and the United Kindgom are leaders on real price of a pack

of cigarettes. France, Spain, and Netherlands come last, with cigarettes costing

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approximately one-third that of Denmark and the UK. The average range of cigarette

prices across Europe spans around $0.55 in Spain, to $2.60 in Denmark.

From 1980-1990, the range of cigarette prices remains roughly the same, from

$2.60 in the United Kingdom to $0.55 in France and Spain. Figure 5 reveals that

FIGURE 5 Mean Cigarette Price per Pack (US Cents): 1980-1990

0 100 200 300mean of price

FranceSpain

GreeceNetherlands

ItalyBelgiumAustria

GermanyPortugalFinland

SwedenIreland

DenmarkUnited Kingdom

Mean Cigarette Price

Source: OECD National Accounts (2006).

Ireland replaces Sweden in the top three countries with cigarettes per pack over $3.00:

United Kingdom, Denmark, and Ireland. Portugal and Belgium are the biggest cost

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movers (increase) from the previous decade, while Denmark, Sweden, Italy, and France

all experience a drop in the cost of cigarettes. Germany and Austria undergo only slight

changes over the decade.

In the final decade included in this study, 1990-2000, price leaders continue to be

the United Kingdom, Ireland, Denmark and Sweden. Figure 6 shows how the cost of

cigarettes goes beyond $4.00 a pack in the United Kingdom. Also, the number of

countries in the $2.00 to $3.00 range doubles from the previous decade.

FIGURE 6 Mean Price for Cigarette Packs (US Cents): 1990-2000

0 100 200 300 400mean of price

SpainGreece

ItalyPortugal

FranceGermany

NetherlandsAustria

BelgiumFinland

SwedenDenmark

IrelandUnited Kingdom

Mean Cigarette Price

Source: OECD National Accounts (2006).

93

Spain and Greece continue to lag with price increases, while France makes the biggest

price increases, more than doubling the price of a pack of cigarettes from the average in

the previous decade.

Taken together, these figures descriptively demonstrate the variation in average

price for a pack of cigarettes across Europe from 1970-2000. Ultimately, taxation (and

therefore price increases) controls tobacco consumption by manipulating demand for the

addictive commodity (see Chapter III). To the extent that demand elasticities can be

moved, tobacco economists argue that price policies are the most effective mechanism

for reducing tobacco consumption (Chaloupka 1991, 1997; Warner et al 1995;

Wasserman et al 1991). Under this argument, price policies are inversely linked to

consumption levels:

Hypothesis 1: Increases in cigarette price reduce demand for cigarettes.

Therefore, consumption is modeled as a function of price:

O = ƒ (Price-Policy) [1]

where O is some policy outcome, cigarette consumption, modeled as a function of the

price of cigarettes, which reflect taxation changes. While this argument [1] has merit, it

is critical to consider countervailing messages sent to consumers when governments use

tobacco taxation as a deterrent: 1) cigarette taxes provide useful revenue for government,

so consumption is profitable and 2) price increases are meant to deter consumption of an

unhealthy commodity.

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Price policies act as uniform market mechanisms with the goal of making it in

consumers’ self-interest to reduce consumption. The overarching goal is to use price

mechanisms to deter demand of a product, without having to communicate a strong

statement of preference over whether a product cannot or should not be consumed or

banned. The consumer still has the choice of buying and smoking cigarettes if willing to

pay a higher price. Material costs include both those expended at purchase, as well as

those associated with future health problems. In liberal democracies where governments

often bear a portion of the cost in providing health coverage, this is a decision the

government hopes the consumer takes seriously. Many consumers do not consider future

risks and therefore operate according to what the tobacco economics literature terms

imperfectly rational addiction models of consumption (Elster, 1979; McKenzie, 1979;

Winston, 1980; and Thaler and Shefrin, 1981). In order to curb consumption in such

circumstances all European countries have initiated non-price policies alongside

taxation.

Non-price Tobacco Policies

Price policies dominated tobacco control efforts across Europe until the early

1980s in most countries, and into the 1990s in places like Austria. The diffusion of

health information across the developed world, especially that from the 1964 U.S.

surgeon’s general report, led governments to begin considering specific health risks

associated with smoking cigarettes. This led to the formation and adoption of non-price

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instruments to regulate the advertising of cigarettes and environmental smoke, as well as

to inform citizens of health risks by using information tools such as warning labels on

tobacco products. Table 1 in Chapter III captures seven non-price policy instruments

used to control tobacco in Europe. They are: advertising, sales, environmental tobacco

smoke, ingredients, health warnings, capacity-building, and educational campaigns.

In the tobacco literature it is common to conduct descriptive policy analysis of

the potential impact of a single policy. Examples include studies of the marketing policy

outlined in the master settlement agreement between Big Tobacco and the United States

(Slade 2001), regulation of nicotine delivery systems (Warner et al 1996; Cromwell et al

1997), restriction of cigarette sales to minors (Rigotti, 2001), and implementation of

state clean indoor air laws (Schroeder, 2004). However, these policies are often adopted

and implemented within a larger social regulatory context where other regulations are

already in effect and policy environments differ with respect to how they support policy

efforts.

Meier and Licari (1998) and Licari (2000) were first to respond to this concern

by evaluating the effectiveness of tobacco control when policies are implemented in

combination. Three key U.S. federal policies are analyzed in combination: cigarette

taxation, cigarette package warning labels (effective January 1, 1966; Fritschler and

Hoefler 1995), and the television advertising ban in 1971. The proliferation of policy

instruments across Europe from 1970-2000 makes clear the need for a finer

determination of what works and how. I build on Meier and Licari’s (1998) framework

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to address this need. Within that framework, there are seven main instruments of

tobacco control. Many of these policies share behavioral assumptions. These underlying

characteristics enable me to account for European tobacco control efforts using

combined indicators which reflect common underlying notions by isolating shared

variance among multiple policy instruments.

In building a model of comparative public policy, it is important to first identify

those policies relevant to the outcomes of interest (e.g., tobacco consumption), and then

to think about associations among policies. In [1] above I start building a model of

European tobacco control effectiveness, focusing on price policies. Non-price policies

are added to that model:

O = ƒ (Price-Policy, Non-Price Policies) [2]

where O is some policy outcome, cigarette consumption, modeled as a function of the

price of cigarettes, and non-price policies which are identified qualitatively (see Table 2,

Chapter III). These non-price policies [2] alter demand curves of smokers and can be

broadly sorted conceptually two ways: a) according to whether they convey information,

or whether they are command and control regulation [3] or b) according to whether their

behavioral attributes can be captured as a non-price policy bundle [4].10

10 This strategy is useful when simultaneous policy adoption makes it difficult to disentangle certain specific policy-effects given data limitations.

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O = ƒ (Price-Policy, Non-Price Policies)

Information Policy Command-Control Policy [3]

Non-Price [4] Policy Bundle

Information Policy

Like the United States, in Europe the foremost battle to control tobacco from

both the perspectives of industry and government is on the control of information about

tobacco products. Many governments wish to uncover and disseminate harmful

information about tobacco products, while industry representatives work to suppress,

manipulate, or constrain information touting harmful information of their products.

Information instruments help governments build negative information campaigns which

support an overall emphasis on governing and protecting the public health of citizens.

While information policies can be costly, and heavily dependent on whether they are

ignored by consumers (Meier and Licari, 1998), many governments use them to aid in

governing public health.

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The most notable implementation example is the requirement of warning labels

on cigarette packages. Notwithstanding voluntary agreements, warning labels began to

appear in national-level legislation around the 1980s across Europe. Chapter III

illustrates the variety of labels adopted, some only hinting at possible harmful effects,

others passing along strong and specific dangers of smoking.11 As of the late 1990s all

western European countries require warning labels by law to appear on cigarettes

packages (Aspect Consortium, 2004).

Other methods of implementing information include national educational

campaigns designed to disseminate information on smoking and public health. While

most European countries likely have anti-tobacco educational campaigns supported by

state and local governments and non-governmental entities, three countries in the

European Union have national legislation supporting the dissemination of the dangers of

tobacco: France, Spain, and Sweden (Shafey et al, 2003). While coverage on

educational campaigns varies by country, these initiatives add to overall negative

information policy emphasized and enforced at the national level.

While warning labels and educational campaigns represent different avenues to

controlling tobacco, as policy instruments they share attributes of providing consumers

with information, allowing consumers to decide for themselves whether and how much

risk is acceptable. Policy outcomes, therefore, are expected to respond to regulatory

efforts aimed at providing information:

11 In Chapter VI, I introduce more recent efforts by the European Union to regulate negative information via labels on cigarette packages.

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Hypothesis 2: Cigarette demand will diminish as governments adopt policy instruments

aimed at correcting information asymmetries associated with tobacco

products.

Now the comparative model [4] is expanded to include these factors:

O = ƒ (Price-Policy, Non-Price Policies) [5]

Information Policy Command-Control Policy

Health Warnings Educational Campaigns

Command-Control Policy

In addition to information policies, governments choose among command and

control (CAC) policy instruments once specific intent to regulate is settled. Tobacco

control is no exception. Across the European Union, CAC policies have been used to

restrict the advertising of tobacco products, primarily across television and radio media.

Though, some restrictions are also enforced across subsets of print media. These policies

are designed to restrict, or at least constrain, the information provided by tobacco

companies to sell products to consumers.

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Substantial CAC efforts have also been directed towards setting standards and

restrictions on the ingredients of tobacco products, primarily manufactured cigarettes.

Limitations are often placed on tar and nicotine yields, as well as on additives which

make the product more appealing and addictive. Ingredients are often required to appear

on cigarette packs, so that tobacco companies are held accountable for their contents,

if/when tested. These labels also communicate information to consumers, though they

are often ignored or hard to understand. Most consumers do not know how to calculate

risk based off information reported on labels.

Setting standards for the restriction of tobacco sales is another CAC effort.

Minors can be restricted from purchasing or consuming cigarettes in retail stores or from

vending machines. These policies are designed to curb consumption by restricting access

to the product. Finally, governments set standards for controlling environmental tobacco

smoke in public buildings, in transportation vehicles, or in areas where minors are

present (see Chapter III for more implementation examples).

While each of these CAC efforts represent different avenues to control tobacco,

as policy instruments they share attributes of setting standards for what is permitted, and

for building in control mechanisms to ensure compliance (see capacity-building

instruments in Chapters III and VI). Policy outcomes are expected to respond to those

instruments which set specific standards and build capacity for regulation:

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Hypothesis 3: Cigarette demand will diminish as governments adopt policy instruments

which standardize regulatory efforts and create capacity for ensuring

compliance.

This differs from information policy instruments which correct information

inefficiencies so that consumers can decide for themselves whether and how much risk is

acceptable. Now the comparative model [6] is expanded to include CAC factors:

O = ƒ (Price-Policy, Non-Price Policies) [6]

Information Policy Command-Control Policy

Health Warnings Advertising Educational Campaigns Sales Environmental Tobacco Smoke (ETS) Capacity-Building

Multiple Interventions

The regulatory environment for tobacco often includes non-price and price-

control efforts aimed at shifting demand. While combined policy efforts may seem

progressive, policymakers often rush to adopt multiple instruments without

consideration for how they may detract from overall effectiveness when executed in

combination. Meier and Licari (1998) are the first to consider how instruments work

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when used in combination. They argue as non-price regulation is added, less-addicted

smokers are skimmed off, leaving a pool of highly addicted smokers, making demand

for cigarettes more inelastic to price. I test this argument in the context of European

tobacco control:

Hypothesis 4: When information policy instruments are added to the regulatory setting,

the effectiveness of price as a disincentive diminishes.

Hypothesis 5: When command-control instruments are added to the regulatory setting,

the effectiveness of price as a disincentive diminishes.

Another extension of Meier and Licari’s (1998) formal postulate is to test their

hypothesis on the interaction between command-control and information policies. Since

I do not have a theoretical expectation for this interaction, I do not test it empirically.

Habit Persistence: Robust Contextual Factor

While both price and non-price policies are ultimately designed to effect

consumer demand for tobacco, the unique characteristic of tobacco products is their

addictive quality. This trait makes shifting demand curves difficult since smokers range

from highly addicted to not addicted.

Within the tobacco control literature, habit persistence is typically taken into

account by including a measure of past consumption (Chaloupka and Warner 1999;

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Becker and Murphy 1988; Lewit, 1989; Meier and Licari 1998). When controlling for

price, habit persistence can also be taken as demand elasticity for tobacco products. The

closer to 1 this number is, the more inelastic demand for this addictive commodity.

Conceptually, habit persistence captures direct levels of demand, as well as more

indirect moods in the population where declining consumption may indicate decreasing

popularity of legitimacy of smoking (Licari, 2000).

Hypothesis 6: As habit-persistence intensifies, current demand and consumption of

tobacco products increase.

To be aware of addiction when determining the effectiveness of tobacco control

brings to light the importance of incorporating knowledge of the substantive policy area

when developing a model. The following addition is made to the comparative policy

model [7] of tobacco control effectiveness:

O = ƒ (Price-Policy, Non-Price Policies, Robust Contextual Factors) [7]

Information Policy Command-Control Policy Habit Persistence

Health Warnings Advertising Educational Campaigns Sales Environmental Tobacco Smoke (ETS) Capacity-Building

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In Chapter I, I contend hat policy effectiveness depends not only on appropriate

selection of policy instruments; policies are conceived of and implemented within

policy environments. Whether the policy environment is supportive of tobacco control

influences the extent to which these price and non-price policy instruments lead to

effective intervention. Bureaucratic, industrial, and political forces are three dimensions

of the policy environment which enable and constrain policy effectiveness.

Bureaucratic Influences

An instrumental view of policy effectiveness takes into consideration how

bureaucracies influence policy outcomes. Bureaucracies generally exercise their

influence in policymaking because they are inherently involved with government

regulation of industry (Meier, 1993).

During the time period under examination, 1970-2000, the most influential

bureaucracy with a stake in the politics of tobacco across Europe is the public health

bureaucracy. The presence and strength of public health bureaucracies across member

states should have two important influences on tobacco control outcomes. First, they are

uniquely positioned to provide information to the public on health risks associated with

smoking, thus reducing consumption. Secondly, they can influence political actors to

increase the scope and severity of price and non-price policy efforts to reduce smoking.

Such actions align with policy agendas focused on improving public health in an area

where health is aggressively under assault. Additionally, bureaucracies utilize various

resources (budget allocations and personnel, for example) to pursue their policy agendas

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(Rourke 1986), according to their capacity. Increased capacity should lead to efforts

aimed at governing (improving) public health, by reducing consumption of harmful

products like cigarettes. Bureaucratic capacity, specifically via resources, is linked

inversely to policy outcomes:

Hypothesis 7: As public health bureaucracies increase their capacity (expenditures) to

align efforts with policy agendas focused on improving public health,

cigarette demand will diminish.

Industry Influences

Tobacco companies and subsidiaries are present in every European Union

member state (Harvard School of Public Health, 2001). While a stronger industry

presence can be accounted for in Great Britain, Germany, Italy, and Greece (for

production, manufacturing, and distribution), the positioning of tobacco firms across the

European Union is pervasive (United Nations Food and Agricultural Organization,

2005). This is not to say there are many – in fact, there are only a few firms. They are

simply spread across the Continent in various ways.

Given this presence, industry involvement in the politics of tobacco comes with

the goal of limiting the extent to which policies regulate its products, especially

manufactured cigarettes. The industry has a comparative advantage when exerting itself

politically to constrain, even thwart, policy efforts to reduce consumption. With

relatively few firms, organizing becomes easier because the collective action problem is

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curtailed (Olson 1971). Smaller numbers lower the costs of organizing and ensure

greater benefits for each individual member (Olson 1971).

Even more, institutions structure the pattern of influence exerted by organized

groups in the policymaking process, which has relevant implications for policy

outcomes. For example, pluralist versus corporatists institutional structures make a

difference for how these groups are involved in the policy process and how they are

integrated with other peak organizations at the national level (Schmitter 1982; Lijphart

1999).

While the subject of pluralism and its contrast with corporatism has been a major

focus of interest group politics in the comparative arena (Almond 1983; Wilson 1990),

less attention has been given to policy outcomes resulting from these institutional-

guiding processes. I posit that organized groups from the tobacco industry have more

success at protecting themselves from regulation in those arenas where they can use

uncoordinated pluralist arrangements to exercise their comparative advantage in

organizing, where the potential for integration into the policy process (and fusion to

government representatives) is less formal, and where the environment for policy

concertation (Schmitter 1989) does not require a commitment to tripartite pacts with

national peak organizations, which may dilute their (tobacco industry) message. Within

pluralist arrangements, many groups traverse in and out of the political arena, often only

making an appearance and not exerting an influence. Without a comparative advantage

in organizing, exerting influence can be difficult because groups are not systematically

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integrated into existing peak organizations (Lijphart 1999) (e.g., disparate public health

advocacy groups).

Furthermore, the institutional structures of rigid corporatism (where interest

groups are organized into hierarchical, monopolistic, specialized peak organizations)

prevent access and integration of a multiplicity of interest groups into certain

policymaking spheres. These positions are typically reserved for groups representing

economic affairs (Pekkarinen et al, 1992), not social regulatory affairs, like those

associated with tobacco control.

The enabling characteristics of pluralist interest group arrangements should have

two important influences on policy performance of tobacco control. First, this

arrangement allows tobacco firms to strengthen their bargaining position in the

policymaking process (due to their comparative advantage in organizing over other

groups), which stands to stabilize if not increase demand of their products. Secondly,

being integrated into the political subsystem under these conditions allows tobacco firms

the strategic opportunity not only to advocate their preferences, but also protect

themselves from counter-positions, like those presented by public health advocates.

Under these circumstances the magnitude of regulatory influence on curbing

consumption may be reduced or negated entirely.

Hypothesis 8: In member states where pluralist institutions guide tobacco industry

involvement in policymaking, cigarette demand will increase.

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Political Factors

Institutions which guide the interest group process can also be considered

political factors. However, there are a number of other political factors to consider,

though many of them do not provide tractable implications for policy outcomes. In

covering approaches to tobacco control research, Chapter I explains how direct partisan

political forces are not easily matched to preferences on tobacco control, nor are they

stable determinants of tobacco consumption or cigarette tax rates when crudely

measured (Licari 2000). In the case of the United States, political forces at the state level

are reduced to whether a state is a “tobacco state”: one that grows or manufactures

tobacco (Licari 2000). Across the European Union, however, tobacco firms and

subsidiaries are present in every member state. It is not useful to apply this method

(“tobacco state” designation) to EU member states.

Other than partisan political factors, there may be important political factors

specific to the supranational arrangement of the European Union. Two important

considerations are whether a policy mandate exists for governing public health at the

European level, and the extent to which national governments have adopting EU

legislation into their national laws and regulations regarding tobacco control. These two

factors are considered in Chapter V.

Taken together, bureaucratic, industrial, and political forces comprise the policy

environment portion of the comparative model of tobacco control effectiveness [8],

which have implications for policy performance:

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O = ƒ (Price-Policy, [8]

Cost of tobacco, tobacco taxation

Non-Price Policies,

Information Policies Command and Control Policies Policy bundle

Robust Contextual Factors,

Habit Persistence, Addiction Policy Environment,

Bureaucratic Factors

Industry Factors

Political Factors )

Measuring Concepts and Data

In the previous section, a comprehensive model is developed for determining

how policy-related concepts are linked to policy performance in the arena of tobacco

control in the European Union. While this model is portable as a more general model of

comparative policy effectiveness, this section focuses on operationalizing and measuring

concepts according to the model [8] in the European context.

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Dependent variable. For model [8], the dependent variable of interest is the

number of packs of cigarettes per capita consumed in each member state, 1970-2000. 12

Chapter I illustrates variation in cigarette consumption over time, and across space.

Alternative dependent variables could include consumption of pipe tobacco, snuff, or

hand-rolled tobacco cigarettes. However, because seventy-five percent of tobacco

consumed in the European Union is in the form of manufactured cigarettes, the most

valid policy outcome measure is packs of cigarettes consumed per capita in each

member state, overtime (European Commission Employment and Social Affairs, 2000).

Data related to tobacco consumption come from the European Health for All database.13

Price-Policy: Cigarette Price. Taxes are an important component of price,

especially for regulated commodities. Cigarettes are taxed in a variety of ways.

European taxation practices commonly combine excise taxes and value added taxes

(VAT). These taxes are reflected in the real price of cigarettes, which are passed along to

consumers. As such, the main price-policy indicator is the price of cigarettes per pack

(US = 1990). Real cigarette prices have also been used in other quantitative studies

(Becker and Murphy 1988; Barnett 1995; Meier and Licari 1998; Licari 2000). Data for

cigarette prices come from two sources. Data from 1970-1990 come from OECD

National Accounts and Historical Statistics Detailed Tables . Data for prices 1990-2000

12 The following countries are included as part of European Union: Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, Portugal, Spain, Sweden, and United Kingdom. These comprise what is known as EU15, prior to 2004 enlargement. 13 This database is hosted by the World Health Organization – Regional Office for Europe.

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are from the World Health Organization Global Status Report on Tobacco or Health.

Prices are adjusted for inflation. 14

Policy Instrument Variables. Policy data come from two major sources: the

World Health Organization and the European Commission Directorate-General for

Health and Consumer Protection.15 For each European Union member state, tobacco

legislation is coded according to which instruments are used. These are organized

according to seven categories (see Table 1, Chapter III). Each policy instrument is coded

as an intervention (Box and Tiao 1975; Meier and Licari 1998). Each intervention

remains in the dataset unless rescinded by future legislation. Interventions accumulate

over time in each category. The benefit of accumulated-intervention analysis is the

preservation of information relating to the existing regulatory environment overtime,

acknowledging that policies are adopted and remain in force, unless overturned by future

regulation (Box and Tiao, 1975). This is an innovation in quantitative tobacco control

research.

In order to reflect the theoretical expectation that policy instruments often

converge on common underlying notions, combined policy indicators are created using

factor analysis. Two strategies are employed. First, I apply principal component analysis

based on the theoretical distinction made in the regulatory policy literature between

command-control and information policies. The scale reliability coefficient among

14 These sources are comparable. Missing data points for all variables are handled using imputation calculations (for extensive review of the benefits of imputation in comparative public policy, see Granberg-Rademacker, 2005). 15 Specific by-country sources are referenced in Chapter III.

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information instruments is, however, calls into question whether this is the most

appropriate way to categorize these policies.

The second strategy assumes no theoretical distinction among policies, only that

the collective behavioral attributes of non-price policies represent another way to

determine how policies and outcomes are connected. One factor analysis is performed

containing all policies using oblique-rotated factors. The retained scores represent a

measure of policy scope. I report findings for both measurement strategies.

Robust Contextual Factors: Habit Persistence. Varying demand elasticities for

cigarettes require the habit-forming nature of cigarette smoking to be considered. Within

the tobacco control literature, the way to model addictive phenomena is via habit-

persistence, that is, by including a lagged dependent variable as an independent variable

(Chaloupka and Warner, 1999; Becker and Murphy 1988; Lewit, 1989; Meier and

Licari, 1997). As with other independent variables, lagged dependent variables should

only be included when theoretically appropriate, as is the case with cigarette

consumption. Intuitively, incorporating a lagged dependent variable into a model places

the entire history of the right hand side variables into the equation (Greene, 2003). In the

case of cigarettes, all of the factors influencing past consumption are controlled for,

highlighting the effect of new information.16

16 One possible statistical disadvantage is that even if errors are not autocorrelated, the lagged dependent variable may be correlated with disturbances, resulting in biased estimators. The degree of bias declines substantially as the number of observations increases relative to the estimated parameters. In the present case, the extent of the bias is unlikely to be large given the large N (400+) and the small amount of residual serial correlation.

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Bureaucratic Factors. The main bureaucracy with a stake in the politics of

tobacco in Europe is the public health bureaucracy. Public health bureaucracies utilize

resources to pursue their policy agendas (Rourke 1986), according to their capacity. In

order to capture bureaucratic capacity, a measure of public health expenditures is

collected for each year, for each EU member state. This measure is the percentage of

government health expenditures allocated for public health. These data come from the

OECD (2003).

Industry Factors. Pluralist versus corporatist institutions structure the pattern of

influence organized groups (the tobacco industry) exert in the policymaking process

(Schmitter 1982; Lijphart 1999). A measure of interest group pluralism is applied from

Lijphart (1999) and Siaroff (1999). This is a stable, overtime indicator based on a

number of factors relevant to the pluralism-corporatism contrast (e.g. presence and

strength of national peak organizations, process of policy concertation, centralization of

wage-bargaining, strength of labor unions). The measure ranges from zero, pure

corporatism, to four, pure pluralism. Table 5 illustrates the variation of this stable

indicator across European Union member states. Pluralist institutions guiding the interest

group process are most prevalent in Great Britain (3.50) and Greece (3.50), while more

corporatist structures are more common in Austria and Sweden.

As posited earlier, the tobacco industry may be more likely to establish

preferences and exercise influence in the policymaking process in more pluralist

situations, rather than under corporatist conditions, in order to reduce the impact of

regulations which reduce demand of its products.

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TABLE 5 Interest Group Pluralism Scores, EU Member States Country Pluralism Score Country Pluralism Score Great Britain 3.50 Germany 1.38 Greece 3.50 Netherlands 1.25 Spain 3.25 Belgium 1.25 Italy 3.00 Denmark 1.12 France 3.00 Finland 1.00 Portugal 3.00 Austria .62 Ireland 2.88 Sweden .50 EU15 Average 2.09 Source: Based on data in Lijphart (1999, 313): 0 = pure corporatism, 4 = pure pluralism. Indicators are stable overtime, 1970-2000, with only cross-sectional variation (Lijphart 1999).

Methods and Data Structure

The units of analysis in this study are fourteen European Union member states:

Austria, Belgium, Denmark, Finland, France, Germany, Greece, Ireland, Italy,

Netherlands, Portugal, Spain, Sweden, and United Kingdom. Data limitations prevent

Luxembourg from being included in the analysis. Data from all fourteen countries are

pooled over a thirty year period (1970-2000), creating 420 observations. I use panel data

diagnostics and modeling techniques to estimate respective parameters.

Panel data sets for economic and social science research boast several advantages

over conventional cross-sectional or time-series data sets (Hsiao, 1985). The most

important advantage pertaining to this study is the leverage gained through econometric

estimation and modeling processes. Pooled data provide a larger number of data points,

increasing degrees of freedom and reducing collinearity among explanatory variables.

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This allows for more efficient estimates and, therefore, more reliable inferences and

generalization to the population. In order to ensure such benefits, particular attention is

given to matters related to poolability, heteroskedasticity, autocorrelation, and

stationarity.

Chow tests of common slopes (cross-section stability) support pooling across

European Union countries (on this topic). However, to subsequently assume errors are

homoskedastic is a risk. In fact, an amount of heteroskedasticity is expected given the

differing variances of variables for subsets of countries. In order to constrain the bias of

any nonrandom error, OLS models are estimated with panel-corrected standard errors

(Beck and Katz, 2004). In addition, three series are tested for stationarity: cigarette

consumption, cigarette price, and public health expenditures. It is possible these series

will not revert back to a constant mean and variance given they can increase and

decrease without bound (De Boef and Granato 1997). Therefore it would be consistent

with the data generating process if they were determined to be non stationary.

Stationarity tests for panel data have advanced in the last five years. Until

recently, it was common to combine individual unit root tests applied on each time series

(i.e. Dickey-Fuller test, KPSS test, and the Phillips-Perron test) using, and reporting, a

simple average across units. Unlike the single time series spurious regression literature

which focuses primarily on whether a series exhibits any trend over time, panel data

spurious regression estimates give a consistent estimate of “ the true value of the

parameter as both N and T tend asymptotically” (Phillips and Moon 2000; Baltagi 2005,

p. 237). This has given rise to a number of panel unit root tests assuming cross-sectional

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independence (Maddala and Wu 1999; Levin et al, 2002; Im et al, 2003) dependence

(Pesaran, 2004; Moon and Pesaran 2004) and cointegration (Pedroni 2004; Larsson et al,

2001).

The Im-Pesaran-Shin panel unit root test is most appropriate for heterogeneous

panels (Im, Pesaran and Shin 2003) and is employed in this case. All three series

mentioned above are considered non stationary when this test is applied. Taking the

first-difference is an appropriate correction for cigarette price. However, when first-

differences of consumption and public health expenditures are taken, overdifferencing is

evident in the full model: r-squared reduces to zero, the direction, magnitude, and

significance of these two variables becomes confused. These are common signs of

differencing when it is not needed. Doing so can generate a moving average process,

which has implications for the general model (Mills 1990). In sum, cigarette prices are

non-stationary or I(1) and can be made stationary by differencing once. The other series

remain partially integrated. To ensure this does not bias the results, residuals for every

model are tested for stationarity, using the Im-Peresan-Shin panel unit root test.

Hypotheses

Using panel data analysis, I investigate the following hypotheses derived from

expectations in previous sections:

Individual Instruments and Policy Performance:

Hypothesis 1: Increases in cigarette price reduce demand for cigarettes.

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Hypothesis 2: Cigarette demand will diminish as governments adopt policy instruments

aimed at correcting information asymmetries associated with tobacco

products.

Hypothesis 3: Cigarette demand will diminish as governments adopt policy instruments

which standardize regulatory efforts and create capacity for ensuring

compliance.

Multiple Instrument Intervention and Policy Performance

Hypothesis 4: When information policy instruments are added to the regulatory setting,

the effectiveness of price as a disincentive diminishes.

Hypothesis 5: When command-control instruments are added to the regulatory setting,

the effectiveness of price as a disincentive diminishes.

Bureaucratic, Industry-Political, and Robust Contextual Factors and Policy Performance

Hypothesis 6: As habit-persistence intensifies, current demand and consumption of

tobacco products increases.

Hypothesis 7: As public health bureaucracies increase their capacity (expenditures) to

align efforts with policy agendas focused on improving public health,

cigarette demand will diminish.

Hypothesis 8: In member states where pluralist institutions guide tobacco industry

involvement in policymaking, cigarette demand will increase.

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TABLE 6 Mapping Hypotheses onto General Propositions Proposition: Description Hypothesis: Number 1b: Policy outcomes are unlikely to decline in those countries where the tobacco industry has 8 industry has the opportunity to exert influence through pluralist interest-group structures. 2: Policy outcomes are likely to decline in those 7 countries where implementation resources are available to support tobacco control efforts. 3: Policy outcomes are unlikely to decline in 6 countries where addiction is more severe. 4: Policy outcomes are likely to decline in those 1-5 countries where policy instruments overcome impediments to policy-relevant action.

Two additional hypotheses concerning policy scope are tested in extended analyses. For

this chapter, these hypotheses map onto propositions coming from Chapter II the

following way:

Findings

Table 7 reports findings for the effectiveness of policy on policy performance,

taking into consideration individual and combined interventions and bureaucratic,

industry-political, and robust contextual factors. I test three models: an information

policy model, a command-control model and a combined policy model.

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TABLE 7 The Effect of Policy Interventions on Tobacco Consumption in the European Union, 1970-2000 Model 1 Model 2 Model 3 Independent Variables Information Command-Control Combined Policy Policy Policy Instruments Information Policy -1.131 -- -.918 (33.92) (-1.56) Command-Control Policy -- -.970 -.280 (-2.41) (-0.400) Change in Price -1.750 -1.60 -1.66 (1.98) (-1.81) (-1.86) Price * Information 2.373 -- 1.48 (3.26) (0.88) Price* Command-Control -- 2.89 1.56 (2.17) (0.57) Bureaucratic Factors Public Health Expend. -7.96 -9.09 -8.42 (% of Health Expend) (-1.67) (-1.88) (-1.76) Industry-Political Factors Pluralist Institutions 1.05 .847 1.02 (2.83) (2.29) (2.72) Robust Contextual Factors Habit-Persistence .894 .890 .890 (33.92) (32.66) (32.91) Constant 13.34 15.01 14.10 (3.04) (3.32) (3.15) R-squared .86 .86 .86 Significance of IPS W[t-bar]b .070 .074 .075

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TABLE 7 Continued Model 1 Model 2 Model 3 Information Command-Control Combined Policy Policy P> Χ2 .000 .000 .000 ρ (autocorrelation coefficient) -.119 -.112 -.117 N 406 406 406 Dependent variable: Annual Per Capita Cigarette Consumption (Packs) for each country, 1970-2000. Information and Command-Control policy indicators are lagged one year. A Prais-Winsten procedure is used to correct for residual autocorrelation. Standard errors are panel corrected and robust to heteroskedasticity and unit correlation. The numbers in parentheses are Z statistics. aIm-Pesaran-Shin test for residual stationarity. A significant t-bar statistic indicates stationarity.

For Model 1, as expected the impact of price and information instruments are

negative. The price coefficient (-1.75) indicates that a price change of one dollar per

pack is associated with a reduction in per capita consumption of 1.75 packs.17 The

lagged dependent variable implies that a price increase will have impacts into the future,

at gradually declining rates. The total impact of a one dollar increase in the price of a

pack of cigarettes is 16.51 packs per person. This is a large amount of tobacco and it

indicates that aggressive use of price policy may be a successful way to dramatically

reduce consumption.

Policy instruments which propagate negative information on the harmful effects

of tobacco also reduce consumption. As governments increase their adoption of

17 The dependent variable is not logged, so one-unit interpretation is appropriate. Diagnostic tests confirm the absence of any aberrant outliers which might have called for taking the natural log of several variables.

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information policy instruments, consumption decreases by 1.13 packs per person. The

interaction between changes in price and the adoption of information policy is

significant and in the expected direction. Because the interaction term for combined

policy is in the model, the coefficient for price is interpreted as the relationship

before information policies are added to existing regulation. For example, as information policies are adopted, the effectiveness of price as a

disincentive diminishes (-1.75 + 2.37 = 0.62).18 This implies that as information policies

are added to the regulatory fabric, price increases need to become quite large to have the

same impact as before.

Also, the addictive nature of tobacco generates a large positive coefficient (.894)

for the lagged consumption variable: habit persistence. This is consistent with

expectations associated with the robust inelasticity of addictive commodities. Despite

this, a one percent increase in public health expenditures reduces consumption by

approximately eight packs per person, annually, even when controlling for industry

efforts to use pluralist institutions to stabilize (even increase) demand for tobacco

products. More pluralist policymaking processes are associated with an increase in

tobacco consumption of approximately one pack per person, annually.

Model 2 reports similar findings. Past consumption remains inelastic (.89) and

price and command-control policies reduce consumption. A one dollar change in price is

associated with a decrease of one and a half packs of cigarettes per person, annually. The

18 While this demonstrates how price incentives diminish, the positive .62 cannot be interpreted as being correlated with an increase in consumption, since the value passes through zero.

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magnitude of this impact is diminished as command-control policies influence less-

addicted smokers, leaving only those more highly addicted (-1.60 + 2.89 = 1.29). The

independent effect of command-control policies, after considering price changes and

other factors remains notable. As government adds command-control policies to the

regulatory milieu, consumption decreases by approximately one pack per person. The

total impact of command-control policies (dividing the command-control slope by one

minus the slope of the lagged dependent variable) is a long-run reduction of

approximately nine packs per person. Expenditures by the public health bureaucracy also

significantly contribute to a decline in cigarette consumption (b = -9.09), even when

taking into consideration increases in consumption due to industry efforts to constrain

regulatory efforts (pluralism b = .847).

In Model 3, the most significant determinants of consumption are price policy,

public health expenditures, past consumption and pluralist institutions. Command-

control and information policies (and their interactions with price) become insignificant.

This could be because the combined model is highly collinear. The issue of collinearity

among non-price policies provides the first indication that command-control and

information policies may not be as distinct as argued previously. I propose a solution for

this issue in the next section that enables me to continue with exploring an instrumental

theory of policy effectiveness.

In sum, Table 7 reports evidence in support of theoretically derived hypotheses.

In separate models of consumption, non-price policies are linked to reductions in

consumption. In these instances, as expected, combinations of these policies with price

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policy diminish their independent effects due to demand-characteristics of the smoking

population – which range from highly addicted to not addicted. There is no evidence

that non-price policies reduce consumption when they are placed in a single model. Price

policies, bureaucratic factors, industry-political factors and habit-persistence remain

robust in reducing consumption in the combined context.

Further Analysis

Up to this point I have made the case that information and command-control

policies work differently in how they affect consumption and are therefore distinct.

While these instruments are coded separately, in reality there are instances of multiple

instruments being adopted within one piece of legislation, making it more difficult to

determine their distinctive impact on consumption. To deal with this problem I develop a

policy-bundle measure of non-price policies. This collective measure still captures

collective behavioral attributes, but prevents any finer assessment of individual non-

price policies in reducing consumption. This strategy allows me to continue applying an

instrumental perspective; one that distinguishes between price and non-price policies,

rather than among non-price policies.

When non-price policies are correlated with one another because of the issue of

simultaneous adoption, factor analysis can be used to develop a collective measure for

empirical analysis. In Chapter III I performed factor analysis using oblique rotation,

which assumes correlation among items. From this analysis I derive a measure for non-

price policy bundles. This measure captures the scope of non-price policy instruments

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used each year in each country. Similar data-reduction strategies have been used in the

social-regulation literature (Durant and Legge 1993; Haider-Markel 1998). As the

scope of non-price tobacco interventions increases, policy outcomes are expected to

respond favorably: consumption is expected to decline (Hypothesis 9).

This expectation, however, cannot be considered apart from pervasive strategies

used by the tobacco industry, which serve to protect and expand demand of their

products. Whether the United States, Canada, or across Europe, one of the most popular

strategies used by the tobacco industry is to convince governments of their position

within the larger state economy. Primary attention is given to the macro contribution of

the commodity by way of production and manufacturing (Studlar 2002). This strategy

has been successful during the time period under investigation. In fact, not only have

some governments subscribed to economic-contribution arguments, many have

historically subsidized the efforts of the tobacco industry. I expect policy efforts to be

less effective at curbing consumption when controlling for the contribution of tobacco

manufacturing to the larger economy (Hypothesis 10).

Table 8 reports findings for the initial analysis on policy scope and policy

performance. Model 1 demonstrates the independent influence of price and non-price

policies in reducing consumption . As the scope of non-price policies increases,

consumption declines at a rate of approximately one pack per person. The full impact of

additional non-price policies overtime contributes to a reduction in smoking by almost

ten packs per capita. Habit-persistence and interest-group pluralism remain associated

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TABLE 8 The Effect of Policy Scope on Tobacco Consumption in the European Union, 1970-2000 Independent Variables Model 1 Model 2 Non-Price Policy Non-Price*Price Policy Policy Instruments Scope -1.04 1.50 (-2.66) (1.13) Change in Price -1.70 -2.00 (-1.92) (-2.27) Price * Scope -1.22 (-2.06) Bureaucratic Factors Public Health Expend. -8.87 -10.26 (% of Health Expend) (-1.89) (-2.23) Industry-Political Factors Pluralist Institutions .767 .703 (2.12) (2.00) Robust Contextual Factors Habit-Persistence .892 .893 (33.87) (34.04) Constant 14.93 16.29 (3.44) (3.78) R-squared .85 .86 Significance of IPS W[t-bar]b .073 .071 P > Χ2 .000 .000 ρ (autocorrelation coefficient) -.104 -.118 N 406 406 Dependent variable: Annual Per Capita Cigarette Consumption (Packs) for each country, 1970-2000. Scope variable lagged one year. Sample is split around the mean of the percent value-added to national manufacturing made by tobacco. The mean contribution is 16.21 percent.

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TABLE 8 Continued. A Prais-Winsten procedure is used to correct for residual autocorrelation. Standard errors are panel corrected and robust to heteroskedasticity and unit correlation. The numbers in parentheses are Z statistics. aIm-Pesaran-Shin test for residual stationarity. A significant t-bar statistic indicates stationarity.

with increases in consumption, while price-changes and public health expenditures

continue to be related to decreases in consumption.

Model 2 reports findings when policy scope is interacted with price policy. The

independent effect of non-price policies becomes insignificant. The impact of price

policy when non-price policies are present cannot be determined since the main effect of

policy scope is insignificant. Despite this, cigarette price, public health expenditures,

pluralist interest group structures and addiction significantly influence consumption in

expected ways.

Table 9 reports evidence on the impact of tobacco manufacturing on

consumption. Non-price policies are not a significant factor in reducing consumption

when controlling for the contribution of tobacco manufacturing to the larger economy.

Price policies remain a powerful tool in reducing consumption. Support from the public

health bureaucracy also continues to significantly impact consumption in a positive

manner. Tobacco manufacturing, pluralist institutions and addiction lead to increases in

consumption. Comparing these results to Table 8, there is no evidence suggesting that

strategic positioning of the tobacco industry in the larger economy influences the

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TABLE 9 The Effect of Policy Scope on Tobacco Consumption in the European Union when Tobacco Manufacturing is Considered, 1970- 2000. Independent Variables Policy Instruments Scope 1.32 (0.98) Change in Price -2.08 (-2.35) Price* Scope -1.10 (-1.83) Bureaucratic Factors Public Health Expend. -9.22 (% of Health Expend) (-2.02) Industry-Political Factors Pluralist Institutions .766 (2.18) Robust Contextual Factors Habit-Persistence .874 (29.98) Tobacco Manufacturing .146 (1.80) Constant 14.58 (3.52) R-squared .86 Significance of IPS W[t-bar]b .017 P > Χ2 .000 ρ (autocorrelation coefficient) -.103 N 420

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TABLE 9 Continued. Dependent variable: Annual Per Capita Cigarette Consumption (Packs) for each country, 1970-2000. Scope variable lagged one year. Sample is split around the mean of the percent value-added to national manufacturing made by tobacco. The mean contribution is 16.21 percent. A Prais-Winsten procedure is used to correct for residual autocorrelation. Standard errors are panel corrected and robust to heteroskedasticity and unit correlation. The numbers in parentheses are Z statistics. aIm-Pesaran-Shin test for residual stationarity. A significant t-bar statistic indicates stationarity.

contribution of other robust factors in determining consumption outcomes. These results

provide mixed evidence in support of the original hypothesis. Tobacco manufacturing

does lead to an increase in consumption, but does not effect how policies, bureaucratic,

industry-political, and robust contextual factors influence consumption.

Conclusion

Overall, I find mixed support for theoretically derived hypotheses. The most

consistent findings are those coming from the policy environment. Implementation

resources from the bureaucracy and structures guiding the way in which powerful groups

engage the policymaking process are significant factors in reducing consumption. The

magnitude effect of public health expenditures is notable. Across six models this

variable contributes to a reduction in consumption in the range of four and twelve packs

of cigarettes per capita. Across the lifetime of data under observation, the impact is 40-

120 packs per capita annually. This is the largest impact of any variable across models.

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The most effective strategy for controlling tobacco may be to increase the capacity of the

bureaucracy to exercise its expertise in governing public health issues.

Another consistent finding is the role pluralist institutions play in promoting

consumption. These institutions benefit the tobacco industry by allowing them the

opportunity to engage the policy process in a way that limits regulation over their

products. Public policies to control tobacco have been less successful across the models.

While price policies consistently contribute to reducing consumption, the evidence for

non-price policies is mixed. In some cases, non-price policies have an independent effect

on consumption. In others, they drop out of significance. They also lessen the impact of

price policy in some instances. In these cases, there is compelling evidence confirming

Meier and Licari’s (1998) formal postulate that combining policy instruments results in

an overall impact less than the sum of their parts. This is the first study to investigate the

postulate cross-nationally, and with consideration for the larger policy environment.

In the end, when comparing instruments, price policy outperforms non-price

policy-bundles. The collective attributes of non-price policies are not enough to reduce

consumption when controlling for other instruments and the larger policy and political

environment. Finally, the unique characteristic of tobacco being addictive poses many

challenges to governing public health through regulatory efforts. A model of policy

effectiveness must consider such challenges when evaluating how policy outcomes

respond to such efforts. When deciding if and how to regulate consumption,

governments would do well to consider:

the aggregate addiction of the target population,

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the capacity of public health bureaucracies to align efforts with policy agendas

focused on improving public health,

the extent to which pluralist institutions guide industry involvement in

policymaking,

whether information policy instruments are aimed at correcting information

asymmetries associated with tobacco products,

the extent to which command-control policies standardize regulatory efforts and

create capacity for ensuring compliance,

whether price and non-price policies are independently and jointly effective,

the degree to which important actors in the policy environment strategically

position themselves according to value-added contributions in matters important

to the government, such as the economy.

The next step in the study involves a careful look at important political factors

specific to the supranational arrangement of the European Union. Two important

considerations are whether a policy mandate exists for governing public health at the

European level, and the extent to which national governments have to adopt European

Union legislation into their national laws and regulations regarding tobacco control.

These two factors are considered important when comparing public policies in multilevel

systems of governance, particularly with respect to tobacco control. How do policy

outcomes respond to regulatory efforts when elements of the supranational arrangement

are accounted for?

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CHAPTER V

TOBACCO CONTROL AND SUPRANATIONAL GOVERNANCE

This chapter extends findings from chapter IV and considers how policy

outcomes respond to policy efforts when taking into consideration attributes of

Europeanization. Ultimately, this fits into my broad concern with how public policies

can be conceived of as mechanisms of governance; how they help negotiate the evolving

relationship between states and societies.

First I discuss how policy directives connect the supranational (EU) level of

governance with member state policy efforts to control tobacco. This discussion is

situated against a background of the general role of policy in the Europeanization

process. Secondly, I explore the role of supranational mandates in governing policy

outcomes at the national level. I empirically investigate whether supranational mandates

have demonstrable effects on the variation of policies pursued across the European

Union and tobacco consumption. Finally, I present findings and implications for

European tobacco control specifically, and the role of supranational governance

arrangements in the study of comparative public policy, generally.

Tobacco Control Directives and European Union

The European Union is one of the most significant laboratories of supranational,

multilevel governance in modern history. In order to properly place tobacco control

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research within the political literature on ‘Europe’ it is necessary to take into account

two broad developments related to public policy within the European enterprise:

European integration and Europeanization. Europeanization is conceptually large and

considers processes through which EU dynamics, whether political, economic or social,

become part of the organizational logic of national politics and policymaking (Harmsen

and Wilson, 2000).19 European integration is part of the Europeanization process and is

more narrowly focused on processes of “policy formulation by a wide range of actors --

representative of governmental as well as non-governmental entities, of member states

as well as of the European Union – engaged in decision making at the European Union

level. Such decision making, including both EU level processes and its outcomes,

generate the economic, institutional, and ideational forces for change in member-states’

policies, practices, and politics” (Schmidt, 2001, p. 20 ). Theories of political integration

predict that policymaking at the EU level increases the probability of achieving policy

goals – goals designed to benefit EU member states and their citizens.

Generally, public policies are inextricably bound with governmental and

institutional bodies in which they are formulated, implemented and evaluated. In

multilevel systems of governance, where delegation of authority exists between levels of

government, this truism comes to life, as does its complexity. For example, the European

level of policymaking – the identification of relevant actors, sources of power and

19 The importance of this process has become more considerable as scholars “of a wide

range of government activities, including industrial, regional, social, and environmental policies, have found they can no longer understand [national] processes and [policy] outcomes that interest them without addressing the role of the European Union.” (Pierson, 1996, p. 130).

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influence, and capacity to exercise power – is broadly envisaged within a larger context

of positive delegation of authority running between Brussels and member states. These

rules of the game, which extend into and from various political entities make patterns of

influence in the policy process difficult to disentangle, and brings to mind a policy-

quagmire.

Within the European Union, there exists much debate on the question of

supranational influence on member state functioning. Theories of integration, such as

intergovernmentalism and neofunctionalism, are at the heart of understanding the impact

of political integration and predict that supranational policymaking will increase the

probability of achieving policy goals salient to Europe. On the one hand,

intergovernmentalism suggests that public policy coming from the supranational level

reflects state-centric diplomacy whereby member states are super-sovereign and seek to

maximize their own advantage (Garrett, 1992; Moravcsik, 1993; Pierson, 1996). From

this perspective, policy outcomes are a consequence of member state preferences, which

are more likely to be heavily weighted and reflected in European directives, orders and

legislation.

This is quite different from policy outcomes predicted by the neofunctionalist

theoretical perspective. Rather than a member-state centric influence, neofunctionalists

attribute greater autonomy to supranational actors who often act independently in the

policymaking process – as in, for example, the Commission or the European Court of

Justice. In this case the scope of member state authority appears far more circumscribed,

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and “both the interventions of other [non-state] actors and the cumulative constraints of

rule-based governance more considerable” (Pierson, 1996, 131).

Supranational directives reflect combined notions of intergovernmentalism and

neofunctionalism, and have been the most common instrument of tobacco control at the

EU-level. Supranational directives are “binding recommendations upon each member

state to which they are addressed, but leave to national authorities the choice of form and

methods” (Nugent, 1999, p. 246). Directives communicate policy principles that member

states must achieve (neofunctionalism), but can pursue by appropriate means under their

respective national, constitutional, administrative and legal systems

(intergovernmentalism) (Nugent, 1999). Directives are also an instrument of policy

harmonization, which is a major goal and characteristic of Europeanization. This

supranational course of action is traditionally accepted as a means for increasing the

probability of achieving desired policy outcomes; and furthermore that the European

Union enterprise provides some value-added function to what member-states can

achieve on their own, or in intergovernmental, regional, or dyadic policy exchanges.

During the time under study, 1970-2000, there were six major tobacco control

directives adopted by the European Union dealing with labeling, advertising, ingredients,

and taxation (Table 10). These directives were concerned with harmonization and

approximation of laws and practices of tobacco control activity across the Union.

Therefore, they were applicable to all member states. All EU directives considered in

this study were adopted between 1989-1998, when supranational progress in the arena of

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TABLE 10 Supranational Directives for Tobacco Control Adopted by European Union Directive/Year Policy Instrument Command-Control Information 552/1989 Advertising: Regulation constraining the use of television advertising for tobacco products 622/1989 Ingredients: Tar and nicotine Labeling: Requires yields must be measured and all packs of cigarettes verified to carry a health warning 239/1990 Ingredients: Sets new maximum tar yield of cigarettes 41/1992 Sales: Restriction on sales Labeling: Makes should reflect a priority of previous health health protection, but not warnings more impede the Internal Market. Specific 79/1992 Taxation: Requires a specific level of excise duty be charged for tobacco products. 43/1998 Advertising: Bans tobacco advertising in the EU Source: Gilmore and McKee (2004).

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public health was on the rise (Gilmore and McKee, 2004). However, the pace slowed

down considerably once a mood of caution about the pace of change in Europe

developed and the principle of subsidiarity was implemented in 1992 (Gilmore and

McKee, 2004). This principle clarifies the role of supranational governance in areas of

policy competence better served by member-state action (Nugent, 1999). The Treaty

Establishing the European Community (TEC) holds that: “The Community shall act

within the limits of the powers conferred upon it by this Treaty and of the objectives

assigned to it therein. In areas which do not fall within its exclusive competence, the

Community shall take action, in accordance with the principle of subsidiarity, only if and

in so far as the objectives of the proposed action cannot be sufficiently achieved by the

Member States and can therefore, by reason of the scale or effects of the proposed

action, be better achieved by the Community. Any action by the Community shall not go

beyond what is necessary to achieve the objectives of this Treaty” (Article 3b, TEC).

This article simply implies policies should be decided at the national, regional or

local level, whenever possible (Nugent, 1999). Before the principle of subsidiarity was

in place (pre-1992), a number of European Council directives were adopted to control

tobacco. Between 1992 and 2000 only one directive was passed (EurLex, 2005). The

first major European Council directive relevant to existing member states was enacted in

October 1989. This directive prohibits tobacco advertising on television by controlling,

more strictly, the promotion and production of television programs. It specifically

prohibits the representation of misleading information of tobacco products and services

to potential consumers, while also discouraging behavior prejudicial to consumer health

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(Eurlex, 2005). Member states are required to pursue rules and procedures which ensure

these standards of regulation.

The second major directive shifted attention towards regulating ingredients and

labeling of tobacco products. The main goal of the directive is to uphold a high level of

health protection by reducing the harm done to health by tobacco addiction. In order to

achieve this policy aim, tar and nicotine yields are required to be measured and verified

according to international standardization (ISO) methods (EurLex, 2005). These yields

are required to appear on cigarette packs along with general warnings of health risks of

tobacco consumption. This directive imposes a community-wide requirement that all

packs of tobacco products carry the general warning, “tobacco seriously damages

health” (WHO, 2004). Health warnings are to be printed in the official language(s) of the

country of final marketing, located on the most visible surface, alternated with more

specific warnings (EurLex, 2005).

Supranational product regulation began in 1990 with a directive intended to

establish new maximum tar yields of cigarettes. The tar yield of cigarettes marketed in

member states is not to exceed 15 mg per cigarette (through 1992) and 12 mg per

cigarette (through 1997). Measurement and verification of this ingredient is to be

managed according to ISO standards (EurLex, 2005).

In 1992 a directive was adopted requiring cigarette packs to carry more specific

warnings. Compulsory rotation of health warnings is instituted and member states are

strongly encouraged to attribute and indicate a source of authority for health warnings

(for example, a surgeons’ general or the Department of Public Health, etc). While the

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restriction of tobacco sales are supported in this directive, the Council is careful to

protect against government action which may impede functioning of the internal market

(EurLex, 2005). Finally, this directive encourages member states to couple their

regulatory efforts with health education programs during years of compulsory education

and with general public information campaigns of the harm of tobacco consumption

(EurLex, 2005).

European Union regulation of tobacco by means of taxation began in 1992. This

directive requires member states to impose minimum consumption taxes that comprises:

specific excise duties, a proportional excise duty calculated on the basis of the maximum

retail selling price, and a VAT (value-added tax) proportional to the retail selling price.

The overall tax rate is to be at least 57% of the retail selling price for cigarettes in

highest demand.

The most controversial supranational directive related to tobacco advertising was

implemented in 1998. Initially, this directive banned tobacco advertising in all 15 EU

member states, covering all forms of advertising apart from television advertising

already covered by previous directives. Any existing sponsorship of events or activities

was only allowed to continue for a period of eight years, ending no later than October

2006. Though not discussed extensively, the European Court of Justice overturned this

directive and the Council implemented less severe advertising bans (Official Journal,

152).

Finally, there are additional directives related to tobacco control beyond the time

frame of this project. However, these directives are important to the discussion of the

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European Union involvement with voluntary, international agreements on tobacco

control. These are discussed in the next chapter on the future of tobacco control research

in Europe.

The question of how to gauge the impact of these directives is important. There

has only been one quantitative study of the impact of EU directives on tobacco

consumption (see Licari, 2000). In this paper, directives are considered as separate

policy interventions from national policy interventions to regulate consumption. This

method is not consistent with how directives are theoretically applied in the context of

multilevel governance. Directives are general policies designed to shape national-

specific strategies to achieving specified policy goals (Nugent, 1999). Perhaps a better

way to gauge the role played by these directives in European tobacco control is to

determine whether they assist in harmonizing policies across member states.20 Two

approaches are taken to demonstrate whether harmonization may be occurring. First, I

gather data on the variation of non-price policy bundles across member states, annually.

Average policy variation is graphed over time with markers indicating the integration of

supranational directives. Because of simultaneous adoption issues, I cannot make a

precise determination of whether certain types of non-price policies are converging

versus others. But, I can capture overall tendencies. I expect supranational directives to

lead to the harmonization of tobacco control policies across member states overtime.

Secondly, I apply this method to cigarette price over time. I expect variation to narrow

after the adoption of supranational directives targeting price. Together these two items

20 Given data limitations I cannot construct a measure of harmonization.

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produce evidence of harmonization, but do not offer a reliable measure of harmonization

which could be used in an empirical test of consumption. Proposition 6 in Chapter II,

therefore, cannot be fully tested. This proposition states that supranational directives

may lead to harmonization of tobacco control policies across member states and

consumption is likely to decline in those countries where efficiency-gains are realized

through the harmonization process.

Figure 7 reports the average variation of non-price policies implemented by

European countries from 1970-2000. Because the variation in non-price policies is based

on the mean level of policy, caution has to be exercised when making claims about

convergence. Therefore, I add additional evidence from the variation of price policy in

Figure 8. Figure 7 reports a gradual overall increase in the average variation of non-

price policies across member states. This confirms that a great of non-price policies are

adjusted for nation-specific concerns. This does not mean that harmonization is

nonexistent. From 1989-1992 there is a major increase, followed by a slower rate of

increase. The latent effect is consistent with the assumption that it takes some time to

harmonize policies once directives are adopted. The second indication of harmonization

occurs between 1996-1999, when policy variation declines.

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FIGURE 7: Variation of Non-Price Policies in Europe: 1970 - 2000

0

.51

1.5

Var

iatio

n

1970 1980 1990 2000year

Source: Shafey et al, 2003.

Figure 8 reports evidence of the average variation in the price of cigarettes over

time. Cigarette price is the best proxy for government policies which target taxation of

addictive commodities. Large increases in the early 1990s are mostly driven by several

countries that began aggressively taxing cigarettes, such as the United Kingdom. There

is evidence of harmonization from 1994-2000, when variation in price declines. Across

both accounts there is evidence suggesting policy harmonization is occurring from the

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FIGURE 8: Variation in Price Policy in Europe: 1970 – 2000

.2.4

.6.8

11.

2P

rice_

Var

iatio

n

1970 1980 1990 2000year

Source: Shafey et al, 2003

mid and late 1990s to 2000. A longer time series would help support this claim, but that

option is not possible given data limitations.

In the next section I contribute more evidence for how Europe matters in

controlling tobacco. Specifically, I focus on the role of supranational mandates play in

reducing consumption. Supranational mandates have been largely overlooked in policy-

performance studies.

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Mandate for European Health Governance: Treaty on European Union

At the European Union level, there is much concern over the continued

consumption of tobacco products, especially manufactured cigarettes. This is due to

increasing numbers of health-related problems associated with consumption, as well as

the incidence of consumption itself. Over forty percent of EU citizens continue to

consume tobacco products, mainly through smoking cigarettes (Economic and Social

Committee Report, 2001). While the incidence of smoking has been in decline for a

number of decades, the rate of decline has fallen considerably in recent decades. From

the view of the Community, the EU is in position to facilitate a more comprehensive

overall strategy to combat smoking (Aspect Consortium, 2004). Therefore, the

Commission works alongside member states to bring tobacco policy into harmonization,

hopefully improving the epidemic by contributing to overall decreases in tobacco

consumption.

Ultimately, policy output the European multilevel system of governance is the

result of complex nested routines (Nugent, 1999). These nested routines are governed by

a system of positive, legal-political authority. The positive legal authority by which the

EU controls tobacco comes from the Maastricht Treaty (or, Treaty on European Union).

In 1992, the TEU was drafted after the relaunching of integration through the Single

European Market program. There was a “growing acceptance of the need for a social-

equity dimension that would offset some of the liberal market/deregulatory implications

of the single market” (Nugent, 1999, p. 60). Most member states were interested in

deepening integration efforts by adding a social dimension to the existing economic

144

mission. The TEU created the ‘European Union’ based on three pillars: the European

Communities, a Common Foreign and Security Policy, and Cooperation in the Fields of

Justice and Home Affairs (Nugent, 1999). Within the first pillar, there were major

developments in two areas: EU institutional changes, and policy changes. Institutional

revisions helped improve various supranational structures and decision-making

processes by making them more efficient and democratic in nature (Nugent, 1999). On

the policy side, the European Union’s policy competence was extended to include the

management of social policy, including several public health matters.

Article 152 within the first pillar states that, “a high level of human health

protection shall be ensured in the definition and implementation of all Community

policies and activities” (EurLex, 2005). More specifically, Article 152 “provides that

Community action shall be directed towards improving public health, preventing human

illness and diseases, and obviating sources of danger to human health. Such action shall

cover the fight against the major health scourges, by promoting research into their

causes, their transmission and their prevention, as well as health information and

education” (EurLex, 2005).

In its response to new health provisions in the TEU, the Commission established

a framework for action in the field of public health to ensure compliance with

supranational law (EurLex, 2005). Tobacco control is integrated into three portions of

this framework: promotion of health, education and training; curbing the cancer

epidemic; and, prevention of pollution-related diseases. Mobilization of government

action in these arenas is expected to remedy, in part, the scale of the problem of the

145

damage to health from tobacco consumption. The Commission response calls for

coordination among member states’ policies and programs towards ensuring a high level

of human health protection. Additionally, the Commission reserves the obligation (by

law) to make any useful initiative to promote coordination, including developing

evaluative criteria, which may compel compliance (EurLex, 2005).

Actions taken in the TEU, European Community policies represented in the first

pillar, and the Commission’s framework for coordinated action establish a supranational

policy mandate. This mandate establishes incentives for member state compliance of

both current directives which are part of national legislative action on tobacco and for

other national policies currently in force. Additionally, the harmonization effect of

supranational policy mandates may create efficiency-gains in member state-efforts to

achieve policy goals. For these reasons, I contend that supranational mandates represent

a policy-feature of European integration which is overlooked in its ability to stimulate or

dampen the effectiveness of government action at the member state level.

By creating a larger macro-incentive policy context, there may also be

implications for factors outside the scope of tobacco policy to influence tobacco

consumption across the Union. For example, the previous chapter presented evidence of

the following factors contributing to reduced cigarette consumption: robust contextual

factors, pluralist interest group structures, bureaucratic factors, policy scope, and

economic factors. Does the establishment of a supranational policy mandate have

implications for if and how these factors influence tobacco consumption?

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Empirical Investigation of a Public Health Mandate

To evaluate whether supranational policy mandates influence the effectiveness of

government action to control tobacco consumption across member states, the

comparative model of tobacco control effectiveness from Chapter IV is employed:

O = ƒ (Price-Policy, [9]

Cost of tobacco, tobacco taxation

Non-Price Policies,

Policy-bundle of all non-price policies

Robust Contextual Factors,

Habit Persistence, Addiction Policy Environment,

Bureaucratic Factors

Industry Factors

Measures of these factors follow the previous chapter. The dependent variable,

O, is a measure of cigarette consumption: packs of cigarettes per capita consumed

annually in each member state (European Health For All Database, 2004). Tobacco

taxation is reflected in the real price of cigarettes. The main indicator of price policy is

the price of cigarettes per pack (US = 1990) (OECD, 2002). Non-price policies are

included as the factor score of all non-price policy instruments: policy scope in a given

year. Habit persistence is captured with an autoregressive measure of cigarette

147

consumption, lagged from the previous years’ consumption level. Bureaucratic capacity

to assist in curbing consumption is measured with public health expenditures, as a

percentage of general government outlay for health (OECD, 2003).

Lijphart’s (1997) scores for interest group pluralism provide a measure for how

institutions structure the pattern of influence of organized groups like the tobacco

industry. The measure ranges from zero, pure corporatism, to four, pure pluralism. To

account for one influence of Europe in curbing consumption by creating a pervasive

incentive-context for member state compliance, a measure of supranational policy

mandate is added to the model. This variable takes on the value of zero before the

ratification of the Treaty on European Union and a value of one in the post-ratification

period.21

The model is tested on a pooled dataset of 14 European Union member states,

1970-2000.22 While chow tests support poolability, heteroskedasticiy is expected given

differing variances of variables for subsets of countries. In order to constrain any bias

which may result from this occurrence, OLS models are estimated with panel-corrected

standard errors (Beck and Katz, 2004). Appropriate action is taken to achieve

stationarity in those series where it is likely to arise. Model residuals are tested for

stationarity, as well, using the Im-Pesaran-Shin test.

21 Denmark, France and Germany did not officially ratify the treaty, by way of referendum, until 1993. However, member state elites in each country continued operating ‘as if’ the treaty were in force (Nugent, 1999). 22 This is consistent with the previous empirical chapter: drawn from the EU15. Luxemborg is not included due to data limitations.

148

Hypotheses and Expectations

As in the previous chapter, cigarette consumption is expected to decrease when

price for tobacco rises, policy scope increases, and public health expenditures rise.

Consumption is expected to increase when demand for tobacco in the previous year

remains inelastic and when the interest group structure (pluralist) favors tobacco industry

efforts to divert policies aimed at reducing demand for their products (see Hypotheses 1-

9 in Chapter IV). Incorporating policy-features of European integration allows for

consideration of how effective these factors remain at influencing consumption, when

operating in a multilevel system of governance:

Hypothesis 11: The presence of a supranational policy mandate for public health

and tobacco control at the EU level magnifies the impact policy

scope, price and bureaucratic factors have on consumption, while

diminishing the impact of habit-persistence and structures which

support the tobacco industry.

This hypothesis is derived from Proposition 5 in Chapter II which states that

consumption is likely to decline when national efforts to control consumption occur

within a supranational context of compliance and commitment to tobacco control,

established through policy mandates. Proposition 6 which states that supranational

mandates provide a context of compliance and commitment which gives rise to

improvements in member state policy performance.

149

Evidence

Table 11 presents findings for the expectation that supranational policy mandates

may add a more nuanced notion of policy effectiveness within multilevel governance

arrangements. Generally, whether a supranational policy mandate is in force, past

consumption continues to be the leading determinant of current consumption. Cigarette

price and public health expenditures also significantly contribute to reductions in

consumption. Pluralist interest group structures contribute to higher consumption rates,

while the influence of policy-scope depends on whether a SPM is in force.

A more careful comparison of Model 1 and Model 2 uncovers several

noteworthy magnitude- effects. First, policy-scope significantly decreases consumption,

when there is a context of supranational commitment to public health and tobacco

control. There is a statistical difference between coefficients of policy-scope in each

model. This finding concurs with the expectation that supranational policy mandates

may activate and/or reinforce member-state implementation and compliance efforts

associated with both recent and seasoned legislative action on tobacco control. This

result, however, cannot be theoretically confined solely to policy-scope; supranational

mandates work through numerous institutions at the member state level, acting as a

pervasive agent of governance.

For example, compare the statistically larger magnitude-effect of public health

expenditures on decreasing consumption, from Model 1 to Model 2. This difference

lends empirical support to how one goal of the public health mandate for tobacco control

150

TABLE 11 The Effect of Policy Scope and Policy Environment Factors on Tobacco Consumption in the European Union when a Supranational Policy Mandate for Tobacco Control is in Force, 1970-2000 Model 1 Model 2 Supranational Policy Mandate (not In-Force) (In-Force) Independent Variables Policy Instruments Scope -.006 -.244 (-0.09) (-2.29) Change in Price -4.96 -.2.31 (-2.23) (-2.56) Price * Scope 1.56 1.48 (0.57) (0.88) Bureaucratic Factors Public Health Expend. -6.95 -38.52 (% of Health Expend) (2.03) (-2.10) Industry-Political Factors Pluralist Institutions .515 2.08 (1.63) (2.33) Robust Contextual Factors Habit-Persistence .930 .874 (45.18) (30.47) Constant 11.22 51.26 (3.09) (2.90) R-squared .90 .78 Significance of IPS W[t-bar]b .003 .038 P > Χ2 .000 .000 ρ (autocorrelation coefficient) -.070 -.042 N 294 126 Dependent variable: Annual Per Capita Cigarette Consumption (Packs) for each country, 1970-2000. Scope variable lagged one year.

151

Table 11 Continued. Sample is split around the mean of the percent value-added to national manufacturing made by tobacco. The mean contribution is 16.21 percent. A Prais-Winsten procedure is used to correct for residual autocorrelation. Standard errors are panel corrected and robust to heteroskedasticity and unit correlation. The numbers in parentheses are Z statistics. aIm-Pesaran-Shin test for residual stationarity. A significant t-bar statistic indicates stationarity.

(increasing comprehensive capacity to combat the tobacco epidemic) may be linked to

improved outcomes (decreased consumption).23

Past consumption and cigarette price are not statistically different across Model 1

and Model 2. Perhaps the magnitude-effect of these factors simply remains high no

matter what additional EU factors are taken into account; they remain robust to policy-

features present in a multilevel context.

Finally, caution is warranted when a sample is divided. There are trade-offs to

inferencing capability when the full-sample is split according to a particular factor – in

this case whether there is a supranational mandate in force. For example, in the previous

chapter there is robust evidence that the scope of policy in force at the national level is a

significant determinant of reduced consumption of cigarettes. In Model 1 (Table 10),

evidence suggests that this effect disappears absent from a context where there is a

supranational mandate for public health and tobacco control. These findings are not at

odds, they simply reflect the possibility that the influence of policy scope on

23 This observation engenders additional interest in how these two factors might link together (more descriptively) by way of particular programs, initiatives, educational campaigns, intergovernmental grants, etc.

152

consumption may be obscured by the sample-split. As such, these findings come with

the caveat that more data points on the post-TEU side of policy context may allow for

this statistical relationship to resurface. This evidence may seem superficial if it is not

considered a portion of a larger exploration on how Europe matters in the effort to

control tobacco. The two approaches taken in this chapter represent a starting point for

studying what could be a productive future enterprise exploring additional supranational

dimensions of tobacco control.

Discussion and Summary

Shifting the traditional focus of the policy discussion from institutional (input-

side) matters towards post-decisional policy affairs allows for assessing how policy

outcomes may respond to national regulatory efforts when elements of Europeanization

are accounted for. This approach to evaluating whether and how Europe matters to

policy effectiveness in a setting of multilevel governance contributes to the undeveloped

discourse in comparative public policy over tobacco control in European Union. As it

concerns tobacco control, member-state policies should be evaluated alongside

supranational mandates which create a context of compliance, and allow for efficiency

gains in achieving policy goals by way of policy harmonization.

In this chapter, I take a careful look at how two particular factors specific to the

supranational arrangement of the European Union might influence policy outcomes: EU

directives aimed at controlling tobacco, and the presence of a supranational policy

mandate for public health and tobacco control. For the first factor, I only present

153

evidence of policy harmonization. I cannot test the link between harmonization and

outcomes due to data limitations. However, I suggest theoretically how both factors are

relevant to the success of community-wide tobacco control. Finally, overall evidence,

evidence supports a framework and method for thinking about the role of different

supranational governance mechanisms in the study of comparative public policy in

laboratories of multilevel governance.

The next step in the study involves bringing together arguments and evidence

presented throughout previous chapters in an effort to offer substantive and theoretical

conclusions, discuss the future of tobacco control in the EU, and articulate the

contribution of this project to the study of comparative public policy and the general role

of policy in connecting states and societies within evolving systems of democratic

governance.

154

CHAPTER VI

CONCLUSION

A General Model of Comparative Public Policy

The tobacco epidemic is politically, socially, and economically salient in the

European Union and around the world. The purpose of this project was to examine the

politics of tobacco, expressed through public policy, in order to understand why certain

interventions were better than others in curbing this epidemic. An instrumental theory of

policy effectiveness was developed to help explain this phenomena. This framework

guided the identification of policy instruments across space and time, articulated

common underlying notions of numerous policy efforts across member states, and made

provisions for how factors in the policy environment and in the macro-political context

of ‘Europe’ influenced policy performance.

Using this simplified theoretical perspective I was able to answer three important

questions concerning policy effectiveness: 1) how can policy instruments be identified,

categorized, and analyzed? 2) which factors in the policy environment are most

important for distilling the effectiveness of individual and multiple policy efforts? and

3) how, and to what extent is policy performance contingent on factors associated with

multilevel governance arrangements?

Three research approaches were useful for conceptual development of dependent

and explanatory factors, as well as empirical model-development: substantive case study

155

of tobacco policy; quantitative historical analysis of tobacco policy across time; and,

quantitative analysis of tobacco control across space. By emphasizing post-decisional

policy consequences (or, policy outcomes), a contribution was made to previous

research orientations in tobacco control which focus mainly on policy development,

adoption and diffusion. In order to simplify this study of public policy, a unified model

was developed and utilized across multiple chapters, drawing on an instrumental view of

policy effectiveness:

O = ƒ (Policy, [10]

Individual policy interventions Multiple policy instruments Scope of policy

Robust Contextual Factors,

Qualitative information on relevant factors driven by policy arena

Policy Environment,

Bureaucratic Factors

Industry Factors

Interest-group Factors

Political Factors

Macro-Contextual Factors

Multilevel governance factors

156

Supranational mandates, international treaties)

This model provided a parsimonious framework of thinking about public policy

and performance. The configuration in which the model is used depends on the context

in which it is applied. However, this model is also a useful framework for future

quantitative, qualitative and formal research in the field of public policy, especially in

comparative context. Further research should explore different functional forms and

contingencies, as well as possible connections between this model and others in public

policy, especially in policy implementation and evaluation.

Instrumental Theory of Policy Effectiveness: Evidence

A number of propositions were introduced in the beginning of the study.

Hypotheses were then derived and tested, empirically. I find support for a number of

these hypotheses. First, price and non-price policies are individually linked to reductions

in cigarette consumption. However, when used in combination, their independent effects

are diminished due to the demand-characteristics of the smoking population, which

ranges from highly addicted to not addicted. Increased bureaucratic capacity also

improves consumption rates, while pluralist interest-group institutions, which favor the

tobacco industry, lead to increases in consumption.

Simultaneous adoption of non-price tobacco policies requires a different strategy

than expected. A measure of policy scope is developed that captures the collective

attributes of non-price policies. When compared, price policies outperform non-price

policy bundles, controlling for a number of factors in the environment.

157

Further analysis reveals that policy performance in the tobacco control arena

cannot be considered apart from pervasive strategies used by the tobacco industry to

position themselves as important contributors in the larger economy. As tobacco

manufacturing increases, so does consumption, even when controlling for other policies

and factors in the policy environment.

Policy performance of member state regulatory efforts were also expected to be

subject to political factors specific to the supranational arrangement of the Euroepan

Union. The Treaty on European Union (TEU) expanded the policy competency of the

European Union to include a number of social-regulatory matters, including public

health. A supranational policy mandate for public health and tobacco control was

established within the first pillar of TEU, and was buttressed by the framework-response

of the Commission to priorities articulated in the TEU. The harmonization effect of this

policy mandate allowed for potential efficiency-gains to be realized in efforts by

member states to achieve policy goals. It also established a super-state commitment to

achieving tobacco control, of which a macro-incentive context of member state

compliance was a part.

Implications for Future Tobacco Control in the European Union

Numerous legislative measures have been adopted to control the production,

manufacturing and consumption of tobacco since 2000 at the EU level. In addition to

using directives, the Commission is managing a Tobacco Fund. The Tobacco Fund is a

community-wide grant program that supports the research and dissemination of

158

information of the harmful effects of tobacco consumption, especially through

manufactured cigarettes, whether active or passive (ETS). Another objective of the Fund

is to improve the relevance of language and images used for health warning, posted on

tobacco products (Aspect Consortium, 2004). Figure 9 shows several warning labels

recently accepted into circulation across the Union. They are indicative of the widening

and deepening of certain policy instruments used to control tobacco consumption:

FIGURE 9 New European Union Labels for Tobacco Products

159

FIGURE 9 Continued.

160

FIGURE 9 Continued.

Source: European Commission on Public Health (2006).

With support from the Tobacco Fund, advertisements and warning labels are

developed by experts in commercial advertising and the medical profession. In order

implement the Fund’s public health objectives at the member state level, a system of

interaction is developed between the regulatory body which manages the Fund and

national authorities and relevant third-sector parties (European Commission on Public

Health, 2006).

161

Another instrument used to govern public health and control tobacco is

supranational funding of international non-profit organizational networks, like the

Euroepan Network for Smoking Prevention. ENSP is financed, in part, by the

Commission and is tasked with coordinating activities of national coalitions, government

officials, and professional experts specializing in smoking prevention and cessation

(European Commission on Public Health, 2006). ENSP also serves in formal

policymaking capacity by facilitating coherence among tobacco control policies at both

national and European levels of governance. While the organization is governed by an

elected board, the Commission is responsible for all management and coordination of the

network.

Finally, the EU has become partner to the World Health Organization’s

Framework Convention of Tobacco Control. The FCTC is the first ever international

treaty on public health. The treaty articulates a set of principles and subsequent actions

for countries world-wide to act against death and disease caused by smoking (European

Commission on Public Health, 2006). The EU took leadership in negotiating the treaty;

and was among the first to see it ratified.

Each of these newly initiated policy instruments (the Tobacco Fund, co-optation

of policy networks, and international cooperation) can be integrated into the general

model above to improve understanding of policy performance, generally, and tobacco

control, specifically, in the context of multilevel governance.

Finally, as the relationship between citizens and government evolves, this type of

theoretical and empirical integration will become necessary, even common place, as

162

policy scholars recalibrate the meaning of ‘policy’ in negotiating governance between

governments and societies and in facilitating democracy in the modern state.

163

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VITA Holly Thompson Goerdel

812 Illinois Lawrence, KS 66044

Ph,D., Political Science, Texas A&M University, May 2007 B.S., Political Science, Texas A&M University, May 2001 Academic Appointment: Assistant Professor, Tenure Track, University of Kansas, August 2005, Publications:

Goerdel, Holly T. 2006. “Taking Initiative: Proactive Management in Networks and Program Performance” Journal of Public Administration Research and Theory 16(3):351-367. Goerdel, Holly T. 2005. “Management Activity and Program Performance: Gender as Management Capital.” Public Administration Review 66 (1), 24–36. With Kenneth J. Meier and Laurence J. O’Toole.

Goerdel, Holly T. 2002. “Structural Funding Policy in the European Union: An Evaluation of the Punctuated Equilibrium Theory.” European Union Notes 1(4):1-17.

Additional Research (preparing for publication): Goerdel, Holly T. 2007. “Multilevel Bureaucratic Governance: Evidence from

Scandinavia” Goerdel, Holly T. 2007. “Public Management and Multilevel Governance:

Europeanization of Strategic Management.” Goerdel, Holly T. 2006. “Strategic Management and Organization Performance:

A Contingency Approach.” (with Laurence J. O’Toole and Kenneth J. Meier)

Invited Presentations: Goerdel, Holly T. 2007. “Public Management Research and Professional Training in International Perspective.” Tsinghua University, Beijing, China. Goerdel, Holly T. 2007. “Modeling Public Management: Using Management/Leadership Survey Questions.” Texas A&M University, Public Management Workshop. Goerdel, Holly T. 2006. “Managerial Autonomy: Finding Empirical and Theoretical Synergies between Political and Administration Notions of Autonomy.” Texas A&M University, Public Management Workshop.